Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-26T03:57:09.724Z Has data issue: false hasContentIssue false
  • English
  • Français

Intravenous Thrombolysis for Acute Ischaemic Stroke in Young Adult Patients

Published online by Cambridge University Press:  04 July 2016

Alexandre Y. Poppe ,
Alastair M. Buchan  and
Michael D. Hill
Alexandre Y. Poppe*
Affiliation:
Calgary Stroke Program, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
Alastair M. Buchan
Affiliation:
Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
Michael D. Hill
Affiliation:
Department of Clinical Neurosciences / Medicine / Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
*
Calgary Stroke Program, University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Intravenous tissue plasminogen activator (IV tPA) has been studied primarily in patients over age 50. We sought to describe baseline differences in adult patients ≤50 years-old taken from a large prospective cohort of acute stroke patients treated with intravenous tPA (IV tPA) and to determine whether outcomes differed for this population.

Methods:

Data (n = 1120) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study (CASES) were reviewed and patients aged ≤50 years-old (n=99) were compared with those aged >50 years (n=1021) with regards to baseline characteristics, symptomatic intracerebral haemorrhage (sICH), functional outcome at 90 days and death.

Results:

Nine percent of patients were ≤50 years-old. Among patients aged ≤50 years, 40.4% were women and median age was 42 ± 6.1 years (range 20 to 50). They had significantly more current cigarette use but fewer other vascular risk factors than older patients (p<0.05) and their baseline median NIHSS score was lower (13 versus 15, P=0.001). Although this group was more likely to have a favourable 90-day outcome, multivariable regression confirmed that age ≤50 years, while independently associated with a decreased risk of death (RR 0.36, 95% CI 0.14 to 0.95), was not itself predictive of favourable 90-day outcome or decreased risk of sICH.

Conclusions:

Adult patients ≤50 years-old had fewer medical co-morbidities and a modestly lower baseline median NIHSS score than their older counterparts. Age ≤50 years was independently associated with a decreased risk of death but not with favourable outcome or risk of sICH.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 2 , March 2009 , pp. 161 - 167
Copyright
Copyright © The Canadian Journal of Neurological 2009

References

1.Bogousslavsky, J, Pierre, P.Ischemic stroke in patients under age 45. Neurol Clin. 1992;10:113–24.CrossRefGoogle ScholarPubMed
2.Kristensen, B, Malm, J, Carlberg, B, Stegmayr, B, Backman, C, Fagerlund, M, et al.Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke. 1997;28:1702–9.CrossRefGoogle ScholarPubMed
3.Kappelle, LJ, Adams, HP Jr, Heffner, ML, Torner, IC, Gomez, F, Billef, J.Prognosis of young adults with ischemic stroke. A long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke. 1994 Jul;25(7):1360–5.CrossRefGoogle ScholarPubMed
4.Marini, C, Totaro, R, Carolei, A.Long-term prognosis of cerebral is chemia in young adults. National Research Council Study Group on Stroke in the Young. Stroke. 1999 Nov;30(l1):2320–5.CrossRefGoogle Scholar
5.Varona, JF, Bermejo, F, Guerra, IM, Molina, JA.Long-term prognosis of ischemic stroke in young adults. Study of 272 cases. J Neurol. 2004 Dec;251(12):1507–14.Google Scholar
6.Rozenthul-Sorokin, N, Ronen, R, Tamir, A, Geva, H, Eldar, R.Stroke in the young in Israel: incidence and outcomes. Stroke. 1996;27: 838–41.Google Scholar
7.Arnold, M, Halpern, M, Meier, N, Fischer, U, Haefeli, T, Kappeler, L, et al.Age-dependent differences in demographics, risk factors, co-morbidity, etiology, management, and clinical outcome of acute ischemic stroke. J Neurol. Epub 2008 lui 28.Google Scholar
8.Adunsky, A, Hershkowitz, M, Rabbi, R, Asher-Sivron, L, Ohry, A.Functional recovery in young stroke patients. Arch Phys Med Rehabil. 1992;73:859–62.Google Scholar
9.Neau, IP, Ingrand, P, Mouille-Brachet, C, Rosier, MP, Couderq, C, Alvarez, A, et al.Functional recovery and social outcome after cerebral infarction in young adults. Cerebrovasc Dis. 1998 Sep-Oct;8(5):296–302.CrossRefGoogle ScholarPubMed
10.Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl I Med. 1995;333(24):1581–7.Google Scholar
11.The NINDS tPA Stroke Study Group. Generalized efficacy of t-PA for acute stroke: subgroup analysis of the NINDS t-PA stroke trial. Stroke. 1997;28:2119–25.CrossRefGoogle Scholar
12.Wagner, IC, Lutsep, HL.Thrombolysis in young adults. I Thromb Thrombolysis. 2005;20(2): 133–6.Google Scholar
13.Hill, MD, Buchan, A.Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ. 2005;172(10):1307–12.Google Scholar
14.Norris, IW, Buchan, A, Cote, R, Hachinski, V, Phillips, SJ, Shuaib, A, et al.Canadian guidelines for intravenous thrombolytic treatment in acute stroke. A consensus statement of the Canadian Stroke Consortium. Can I Neurol Sci. 1998 August;25(3):257–9.Google Scholar
15.Bamford, J, Sandercock, P, Dennis, M, Burn, J, Warlow, C.Aprospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project-198186. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. I Neurol Neurosurg Psychiatry. 1990 Jan;53(l):16–22.CrossRefGoogle Scholar
16.Barber, PA, Demchuk, AM, Zhang, J, Buchan, A.Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000 May 13;355(9216): 1670–4.Google Scholar
17.Biller, J, Adaras, HP Jr, Bruno, A, Love, BB, Marsh, EE 3rd. Mortality in acute cerebral infarction in young adults – a ten-year experience. Angiology. 1991; 42:224–30.Google Scholar
18.Popa-Wagner, A, Carmichael, ST, Kokaia, Z, Kessler, C, Walker, LC.The response of the aged brain to stroke: too much, too soon? Curr Neurovasc Res. 2007 Aug;4(3):216–27.CrossRefGoogle ScholarPubMed
19.Adams, HP Jr, del Zoppo, G, Alberts, MJ, Bhatt, DL, Brass, L, Furlan, A, et al.Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007 May 22;115(20): e478–534.Google Scholar
20.European Stroke Organization (ESO) Executive Committee, ESO Writing Committee: guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25:457–507.Google Scholar
21.Kwan, I, Hand, P, Sandercock, P.A systematic review of barriers to delivery of thrombolysis for acute stroke. Age Ageing. 2004 Mar;33(2): 116–21.CrossRefGoogle ScholarPubMed
22.Schroeder, E, Rosamond, WD, Morris, DL, Evenson, KR, Hinn, AR.Determinants of use of emergency medical services in a population with stroke symptoms (DASH II). Stroke. 2000;31: 2591–6.Google Scholar
23.Scott, P, Silbergleit, R.Misdiagnosis of stroke in tissue plasminogen activator-treated patients. Ann Emerg Med. 2003;42:611–8.CrossRefGoogle ScholarPubMed
24.Kittner, SJ, Stern, BI, Wozniak, M, Buchholz, DW, Earley, CI, Feeser, BR, et al.Cerebral infarction in young adults: the Baltimore-Washington Cooperative Young Stroke Study. Neurology. 1998;50:890–4.Google Scholar
25.Lindgren, A.Roijer, A.Norrving, B, Wallin, L, Eskilsson, J, Johansson, BB.Carotid artery and heart disease in subtypes of cerebral infarction. Stroke. 1994;25(12):2356–62.Google Scholar
26.Radhakrishnan, K, Ashok, PP, Sridharan, R, Mousa, ME.Stroke in the young: incidence and pattern in Benghazi, Libya. Acta Neurol Scand. 1986;73:434–8.Google Scholar
27.Nencini, P, Inzitari, D, Baruffi, MC, Fratiglioni, L, Gagliardi, R, Benvenuti, L, et al.Incidence of stroke in young adults in Florence, Italy. Stroke. 1988;19:977–81Google Scholar
28.Guidetti, D, Baratti, M, Zueco, RG, Greco, G, Terenziani, S, Vescovini, E, et al.Incidence of stroke in young adults in the Reggio Emilia area, northern Italy. Neuroepidemiology. 1993;12:82–7.Google Scholar
29.Leno, C, Berciano, I, Combarros, O, Polo, JM, Pascual, J, Quintana, F, et al.A prospective study of stroke in young adults in Cantabria, Spain. Stroke. 1993;24:792–5.CrossRefGoogle ScholarPubMed
30.Jacobs, BS, Boden-Albala, B, Lin, IF, Sacco, RL.Stroke in the young in the northern Manhattan stroke study. Stroke. 2002 Dec;33(12):2789–93.CrossRefGoogle Scholar