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Thrombolysis in patients with lacunar stroke is safe: an observational study

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Abstract

Research suggests that the etiology of lacunar stroke is different from that of other stroke subtypes. This could imply an altered response to thrombolysis, but data concerning the efficacy of rt-PA in lacunar stroke is limited and inconsistent. From our prospectively collected stroke database, we identified patients with an MRI-confirmed purely lacunar stroke that were treated in our Stroke Unit between 2004 and 2011. We compared both the clinical course (NIHSS, deterioration, mRS at 3 months) and the MRI findings between patients who either received or did not receive rt-PA. In comparison to patients who obtained standard medical care (n = 468), acute lacunar stroke patients treated with rt-PA (n = 69) were more severely affected on admission (median NIHSS of 5 vs. 3; p < 0.001) and presented less frequently with a lacunar syndrome (74 vs. 88 %; p = 0.003). The clinical course was more favorable in patients treated with rt-PA (median NIHSS improvement of 3 vs. 1; p < 0.001), while functional deficit after 3 months was similar in both groups (median mRS of 2; p = 0.211). Overall complication rates did not differ significantly between the two groups, but while we did not detect symptomatic intracranial hemorrhage, hemorrhagic transformation was more frequent in thrombolyzed patients (11.6 vs. 1.9 %; p = 0.001). Patients with acute lacunar stroke benefited from thrombolysis without additional complications. Thus, patients with suspected acute lacunar stroke or lacunar syndrome should not be treated differently than other stroke populations.

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Conflicts of interest

Dr. Griebe, Mrs. Fischer, Dr. Kablau, Dr. Eisele, Dr. Wolf, and Dr. Chatzikonstantinou report no disclosures. Dr. Gass has received honoraria for lecturing, travel expenses for attending meetings, and financial support for research from Bayer Schering, Biogen Idec, Merck Serono, Novartis, and TEVA Neurosciences. Dr. Hennerici is consultant to and has served on advisory boards during the previous 2 years for Servier, Bayer, Boehringer Ingelheim, and received grants from DFG, BMBF, EU and other organizations supporting clinical trials in the Department of Neurology at University Heidelberg in UMM Mannheim. He is Editor in Chief of the journal Cerebrovascular Diseases and board member of other international journals. Dr. Szabo received funding from the German Research Foundation (DFG). She is a member of the editorial board of the journal Cerebrovascular Diseases.

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Authors and Affiliations

  1. Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Martin Griebe, Elisabeth Fischer, Micha Kablau, Philipp Eisele, Marc E. Wolf, Anastasios Chatzikonstantinou, Achim Gass, Michael G. Hennerici & Kristina Szabo

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  1. Martin Griebe
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  2. Elisabeth Fischer
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Correspondence to Martin Griebe.

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Griebe, M., Fischer, E., Kablau, M. et al. Thrombolysis in patients with lacunar stroke is safe: an observational study. J Neurol 261, 405–411 (2014). https://doi.org/10.1007/s00415-013-7212-8

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  • DOI: https://doi.org/10.1007/s00415-013-7212-8

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