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Effects of immediate thrombolytic treatment in imaging area on functional outcome in patients with acute ischemic stroke

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Abstract

Introduction

Door-to-needle time (DNT) is an established predictor of outcome in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Several strategies have been proposed to streamline in-hospital pathways, among which treatment at CT/MR bed.

Aim

To explore the impact of treatment at CT/MR bed, here defined as imaging area (IA), on functional outcome in stroke patients treated with IVT alone.

Methods

All AIS patients treated with IVT alone at our center in 2020, 2021, and 2022 were included. Patients with any previous disability were excluded. The cohort was divided into two groups, depending on the treatment site. One group received IVT at IA, the other at emergency room or stroke unit (non-IA). Regression analysis assessed the association between treatment site and 3-month outcome.

Results

A total of 327 patients who received IVT alone were included in the analysis. One hundred thirty-three (40.7%) were in the IA group and 194 (59.3%) in the non-IA group. The groups showed similar baseline characteristics. In the IA group, DNT was 45 min shorter. Despite similar rates of functional independence (mRS 0-2), the IA group showed higher rates of excellent outcome (mRS 0-1) compared to the non-IA group (60.1% vs 42.8%, p<0.01). Immediate treatment at IA was independently associated to excellent outcome (OR 1.78 [1.03–3.08]).

Conclusions

Thrombolytic treatment at IA lowers DNT and is an independent predictor of excellent outcome after AIS. Our study emphasizes the importance of immediate thrombolytic treatment at IA, soon after radiological eligibility is confirmed. Immediate treatment at IA should be a standard-of-care for AIS.

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Acknowledgements

The authors would like to acknowledge all the professionals involved in stroke care at our hospital, who actively contributed to the improvement of the stroke chain of recovery.

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Author notes

  1. Antonio De Mase and Emanuele Spina contributed equally to this work.

Authors and Affiliations

  1. Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy

    Antonio De Mase, Emanuele Spina, Giovanna Servillo, Stefano Barbato, Gennaro Alfieri, Katia Longo, Walter Di Iorio, Paolo Candelaresi & Vincenzo Andreone

  2. Diagnostic and Interventional Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy

    Giuseppe Leone, Flavio Giordano, Massimo Muto, Gianluigi Guarnieri & Mario Muto

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  1. Antonio De Mase
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Contributions

Drs. De Mase, Spina, and Candelaresi had full access to all data in the study and take responsibility for the integrity of the data.

Concept and design: De Mase, Spina, Candelaresi.

Drafting of the manuscript: De Mase, Spina, Candelaresi. Collection of data: De Mase, Spina, Candelaresi, Servillo, Barbato, Leone, Giordano, Guarnieri, Muto Massimo, Alfieri, Longo, Di Iorio.

Critical revision of the manuscript for important intellectual content: De Mase, Spina, Candelaresi, Servillo, Barbato, Leone, Giordano, Guarnieri, Muto Massimo, Alfieri, Longo, Di Iorio, Muto Mario, Andreone.

Supervision: Candelaresi, Andreone.

Corresponding author

Correspondence to Paolo Candelaresi.

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Ethical approval

Ethical approval was not sought for the present retrospective study because every patient was treated according to the current standard of care. This study was completed in accordance with the Helsinki Declaration as revised in 2013.

Informed consent

All patients or relatives have given written or verbal consent to the clinical procedures and to inclusion in the internal register for subsequent retrospective analysis.

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The authors declare no competing interests.

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De Mase, ., Spina, E., Servillo, G. et al. Effects of immediate thrombolytic treatment in imaging area on functional outcome in patients with acute ischemic stroke. Neurol Sci 45, 1557–1563 (2024). https://doi.org/10.1007/s10072-023-07166-0

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