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- Carrera, Caty, et al.
(författare)
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Validation of a clinical-genetics score to predict hemorrhagic transformations after rtPA.
- 2019
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Ingår i: Neurology. - 1526-632X. ; 93:9
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Tidskriftsartikel (refereegranskat)abstract
- To validate the Genot-PA score, a clinical-genetic logistic regression score that stratifies the thrombolytic therapy safety, in a new cohort of patients with stroke.We enrolled 1,482 recombinant tissue plasminogen activator (rtPA)-treated patients with stroke in Spain and Finland from 2003 to 2016. Cohorts were analyzed on the basis of ethnicity and therapy: Spanish patients treated with IV rtPA within 4.5 hours of onset (cohort A and B) or rtPA in combination with mechanical thrombectomy within 6 hours of onset (cohort C) and Finnish participants treated with IV rtPA within 4.5 hours of onset (cohort D). The Genot-PA score was calculated, and hemorrhagic transformation (HT) and parenchymal hematoma (PH) risks were determined for each score stratum.Genot-PA score was tested in 1,324 (cohort A, n = 726; B, n = 334; C, n = 54; and D, n = 210) patients who had enough information to complete the score. Of these, 213 (16.1%) participants developed HT and 85 (6.4%) developed PH. In cohorts A, B, and D, HT occurrence was predicted by the score (p = 2.02 × 10-6, p = 0.023, p = 0.033); PH prediction was associated in cohorts A through C (p = 0.012, p = 0.034, p = 5.32 × 10-4). Increased frequency of PH events from the lowest to the highest risk group was found (cohort A 4%-15.7%, cohort B 1.5%-18.2%, cohort C 0%-100%). The best odds ratio for PH prediction in the highest-risk group was obtained in cohort A (odds ratio 5.16, 95% confidence interval 1.46-18.08, p = 0.009).The Genot-PA score predicts HT in patients with stroke treated with IV rtPA. Moreover, in an exploratory study, the score was associated with PH risk in mechanical thrombectomy-treated patients.
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| 2. |
- Psychogios, Marios, et al.
(författare)
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European Stroke Organisation guidelines on treatment of patients with intracranial atherosclerotic disease
- 2022
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Ingår i: European Stroke Journal. - : SAGE Publications. - 2396-9881 .- 2396-9873.
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present European Stroke Organisation guideline is to provide clinically useful evidence-basedrecommendations on the management of patients with intracranial atherosclerotic disease (ICAD). The guidelines wereprepared following the Standard Operational Procedure of the European Stroke Organisation guidelines and accordingto GRADE methodology. ICAD represents a major cause of ischemic stroke worldwide, and patients affected by thiscondition are exposed to a high risk for future strokes and other major cardiovascular events, despite best medicaltherapy available. We identified 11 relevant clinical problems affecting ICAD patients and formulated the correspondingPopulation Intervention Comparator Outcomes (PICO) questions. The first two questions refer to the asymptomaticstage of the disease, which is being increasingly detected thanks to the routine use of noninvasive vascular imaging. Wewere not able to provide evidence-based recommendations regarding the optimal detection strategy and management ofasymptomatic ICAD, and further research in the field is encouraged as subclinical ICAD may represent a big opportunityto improve primary stroke prevention. The second block of PICOs (3–5) is dedicated to the management of acutelarge vessel occlusion (LVO) ischemic stroke caused by ICAD, a clinical presentation of this disease that is becomingincreasingly relevant and problematic, since it is associated with more refractory endovascular reperfusion procedures.An operational definition of probable ICAD-related LVO is proposed in the guideline. Despite the challenging context,no dedicated randomized clinical trials (RCTs) were identified, and therefore the guideline can only provide withsuggestions derived from observational studies and our expert consensus, such as the escalated use of glycoproteinIIb-IIIa inhibitors and angioplasty/stenting in cases of refractory thrombectomies due to underlying ICAD. The last blockof PICOs is devoted to the secondary prevention of patients with symptomatic ICAD. Moderate-level evidence wasfound to recommend against the use of oral anticoagulation as preferred antithrombotic drug, in favor of antiplatelets.Low-level evidence based our recommendation in favor of double antiplatelet as the antithrombotic treatment of choicein symptomatic ICAD patients, which we suggest to maintain during 90days as per our expert consensus. Endovasculartherapy with intracranial angioplasty and or stenting is not recommended as a treatment of first choice in high-gradesymptomatic ICAD (moderate-level evidence). Regarding neurosurgical interventions, the available evidence does notsupport their use as front line therapies in patients with high-grade ICAD. There is not enough evidence as to provideany specific recommendation regarding the use of remote ischemic conditioning in ICAD patients, and further RCTsare needed to shed light on the utility of this promising therapy. Finally, we dedicate the last PICO to the importanceof aggressive vascular risk factor management in ICAD, although the evidence derived from RCTs specifically addressingthis question is still scarce
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