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Article

Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective

by
Klearchos Psychogios
1,2,*,
Apostolos Safouris
1,2,
Odysseas Kargiotis
1,
Georgios Magoufis
1,
Athina Andrikopoulou
1,
Ermioni Papageorgiou
1,
Maria Chondrogianni
1,2,
Georgios Papadimitropoulos
1,
Eftihia Polyzogopoulou
3,
Stavros Spiliopoulos
4,
Elias Brountzos
4,
Elefterios Stamboulis
1,
Sotirios Giannopoulos
2 and
Georgios Tsivgoulis
2
1
Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece
2
Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, 12462 Athens, Greece
3
Emergency Medicine Clinic, National & Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, 12462 Athens, Greece
4
Second Department of Radiology, Interventional Radiology Unit, “ATTIKON” University General Hospital, 12462 Athens, Greece
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(13), 2819; https://doi.org/10.3390/jcm10132819
Submission received: 31 May 2021 / Revised: 24 June 2021 / Accepted: 24 June 2021 / Published: 26 June 2021
(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)
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Abstract

Advanced neuroimaging is one of the most important means that we have in the attempt to overcome time constraints and expand the use of intravenous thrombolysis (IVT). We assessed whether, and how, the prior use of advanced neuroimaging (AN), and more specifically CT/MR perfusion post-processed with RAPID software, regardless of time from symptoms onset, affected the outcomes of acute ischemic stroke (AIS) patients who received IVT. Methods. We retrospectively evaluated consecutive AIS patients who received intravenous thrombolysis monotherapy (without endovascular reperfusion) during a six-year period. The study population was divided into two groups according to the neuroimaging protocol used prior to IVT administration in AIS patients (AN+ vs. AN−). Safety outcomes included any intracranial hemorrhage (ICH) and 3-month mortality. Effectiveness outcomes included door-to-needle time, neurological status (NIHSS-score) on discharge, and functional status at three months assessed by the modified Rankin Scale (mRS). Results. The rate of IVT monotherapy increased from ten patients per year (n = 29) in the AN− to fifteen patients per year (n = 47) in the AN+ group. Although the onset-to-treatment time was longer in the AN+ cohort, the two groups did not differ in door-to-needle time, discharge NIHSS-score, symptomatic ICH, any ICH, 3-month favorable functional outcome (mRS-scores of 0–1), 3-month functional independence (mRS-scores of 0–2), distribution of 3-month mRS-scores, or 3-month mortality. Conclusion. Our pilot observational study showed that the incorporation of advanced neuroimaging in the acute stroke chain pathway in AIS patients increases the yield of IVT administration without affecting the effectiveness and safety of the treatment.
Keywords: acute stroke; intravenous thrombolysis; perfusion imaging; CT perfusion; MR perfusion; RAPID acute stroke; intravenous thrombolysis; perfusion imaging; CT perfusion; MR perfusion; RAPID

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MDPI and ACS Style

Psychogios, K.; Safouris, A.; Kargiotis, O.; Magoufis, G.; Andrikopoulou, A.; Papageorgiou, E.; Chondrogianni, M.; Papadimitropoulos, G.; Polyzogopoulou, E.; Spiliopoulos, S.; et al. Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective. J. Clin. Med. 2021, 10, 2819. https://doi.org/10.3390/jcm10132819

AMA Style

Psychogios K, Safouris A, Kargiotis O, Magoufis G, Andrikopoulou A, Papageorgiou E, Chondrogianni M, Papadimitropoulos G, Polyzogopoulou E, Spiliopoulos S, et al. Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective. Journal of Clinical Medicine. 2021; 10(13):2819. https://doi.org/10.3390/jcm10132819

Chicago/Turabian Style

Psychogios, Klearchos, Apostolos Safouris, Odysseas Kargiotis, Georgios Magoufis, Athina Andrikopoulou, Ermioni Papageorgiou, Maria Chondrogianni, Georgios Papadimitropoulos, Eftihia Polyzogopoulou, Stavros Spiliopoulos, and et al. 2021. "Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective" Journal of Clinical Medicine 10, no. 13: 2819. https://doi.org/10.3390/jcm10132819

APA Style

Psychogios, K., Safouris, A., Kargiotis, O., Magoufis, G., Andrikopoulou, A., Papageorgiou, E., Chondrogianni, M., Papadimitropoulos, G., Polyzogopoulou, E., Spiliopoulos, S., Brountzos, E., Stamboulis, E., Giannopoulos, S., & Tsivgoulis, G. (2021). Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective. Journal of Clinical Medicine, 10(13), 2819. https://doi.org/10.3390/jcm10132819

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