Evaluation of stroke prognostication using age and NIH Stroke Scale index (SPAN-100 index) in delayed intravenous thrombolysis patients (beyond 4.5 hours) |
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| Institution: | 1. Stroke Unit – Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy;2. Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt;3. Neuroradiology, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy;1. School of Medicine, Universidad Espíritu Santo – Ecuador, Samborondón, Ecuador;2. Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA;3. Community Center, The Atahualpa Project, Atahualpa, Ecuador;4. Department of Psychiatry, Mount Sinai Morningside, New York, NY, USA;5. Renaissance School of Medicine, Stony Brook University, New York, NY, USA;1. Laboratory of Clinical Applied Anatomy, Department of Human Anatomy, School of Basic Medical Sciences, Fujian Medical University, No.1 Xuefu North Road, Fuzhou, Fujian 350122, China;2. Key Laboratory of Brain Aging and Neurodegenerative Diseases of Fujian Province, Fuzhou 350122, China;3. Public Technology Service Center, Fujian Medical University, Fuzhou 350122, China;1. John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, United States;2. Department of Kinesiology and Health Sciences, College of Humanities and Science, Virginia Commonwealth University and the Division of Cardiology, VCU Pauley Heart Center, Department of Internal Medicine, VCU, Richmond, Virginia, United States;3. Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States;1. Department of Neurology, Kentucky Neuroscience Institute;2. Department of Pathology & Laboratory Medicine, University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA;1. Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan;2. Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan;3. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan;1. MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK;2. UCL Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK |
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| Abstract: | Objectivesthe efficacy of delayed intravenous tissue plasminogen activator (tPA), beyond the 4.5 h window, is evolving. Advanced age and high admission National Institutes of Health Stroke Scale (NIHSS) score are proposed to adversely affect the outcome of delayed thrombolysis and limit the inclusion criteria. The summation of patient age and admission NIHSS score was introduced as the SPAN-100 index as a tool of prediction of the clinical outcome after acute ischemic stroke (AIS). We aimed to assess the SPAN-100 index in AIS thrombolysed patients after 4.5 h.Materials and MethodsThe SPAN-100 index was applied to AIS patients receiving delayed IV thrombolysis (IVT) after 4.5 h. Patients demographics, risk factors, clinical, laboratory and radiological data, mismatch evidence, treatment onset and modality, NIHSS score at baseline and at discharge, and 3 months follow-up modified Rankin Scale (mRS) were reviewed. SPAN-100 score ≥ 100 is classified as SPAN-100 positive while score < 100 is SPAN-100 negative. Clinical outcomes, death and intracerebral hemorrhage (ICH) incidences were compared between SPAN-100 positive and negative groups.ResultsSPAN-100-positive delayed IVT-patients (11/136) had a 6-fold increased risk for unfavorable outcome compared to SPAN-negative patients (OR 6.34; 95% CI 1.59–25.24 p=0.004), however there was no relation between the SPAN-100 positivity and mortality or ICH.ConclusionSPAN-100-positive patients are more likely to achieve non-favorable outcome with delayed IVT in comparison to the SPAN-100-negative patients. SPAN-100 index may influence the eligibility criteria of delayed thrombolysis. |
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