Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units.
Academic Article
Overview
abstract
OBJECTIVE: To examine averted stroke in optimized stroke systems. METHODS: Secondary analysis of a multicenter trial from 2014-2020 comparing patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort were participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue-defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis. RESULTS: Among 1,009 patients with a median last known well-to-thrombolysis time of 87 minutes, 159 (16%) had tissue-defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared to standard management, MSU care was associated with more tissue-defined averted stroke (18% versus 11%; aOR, 1.82; 95% CI, 1.13-2.98) and stroke with early symptom resolution (31% versus 21%; aOR, 1.74; 95% CI, 1.12-2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared non-linear. Most models indicated an increased odds for stroke with early symptom resolution but not tissue-defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower NIHSS, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution. INTERPRETATION: In optimized stroke systems, one-in-four patients treated with thrombolysis recovered within 24 hours and one-in-six had no demonstrable brain injury on imaging. This article is protected by copyright. All rights reserved.
