Facteurs prédictifs du pronostic fonctionnel des infarctus cérébraux sans occlusion proximale traités par thrombolyse systémique

Abstract : Introduction : In the era of mechanical thrombectomy, intravenous thrombolysis (IVT) by tissue plasminogen activator (tPA) remains the first choice of treatment for ischemic stroke with large vessel occlusion. In literature few studies are available regarding the acute phase treatment of ischemic stroke without large vessel occlusion. The existence of potential predictive factors of clinical improvement after IVT treatment in this subgroup of stroke patients is not well established.
Aim of the study : To identify predictive factors of clinical outcome in patients treated with tPA alone for acute stroke without large vesssel occlusion.
Methods : A retrospective analysis of a prospectively collected database of consecutive patients aged over 18 years, hospitalized in Stroke Unit of Nice from January 2012 to August 2016 for acute ischemic stroke without large artery occlusion, treated with IV tPA within 4.5 hours, was realized. Clinical outcome was apprehended by the modified Rankin Scale (mRS) at 3 months. To determine independent predictive pre-treatment variables of good clinical outcome (mRS≤2), univariate and multivariate binary logistic regression models were used.
Results : 162 stroke patients were analyzed in the study. At 3 months, 119/162(76.46%) patients had mRS≤2. The multivariate analysis shouwed that age (/10 years ; OR : 1,62 95%CI[1.10-2.40]), baseline NIHSS (/5pts ; OR : 1.57 95%CI[1.06-2.32]) and admission glycemia (/0.5g/l ; OR 1.63 [1.14-6.25]) were independent predictive factors of poor clinical outcome after IVT.
Conclusion : Age, baseline NIHSS and admission glycemia are independent predictive factors of clinical outcome after IVT. Admission glycemia was the only modifiable independent predictive factor found. Studies are required to demonstrate the potential of an aggressive glucose-lowering treatment for the management of acute hyperglycemia in acute stroke including stroke treated by tPA alone.
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Master Thesis
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Guillaume Colavita. Facteurs prédictifs du pronostic fonctionnel des infarctus cérébraux sans occlusion proximale traités par thrombolyse systémique. Médecine humaine et pathologie. 2019. ⟨dumas-02185624⟩

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