Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units

Babak B. Navi; Ivo Bach; Alexandra L. Czap; Mengxi Wang; Jose Miguel Yamal; Asha P. Jacob; Stephanie A. Parker; Suja S. Rajan; Saad Mir; Carla Sherman; Joshua Z. Willey; Jeffrey L. Saver; Michael O. Gonzalez; Noopur Singh; William J. Jones; David Ornelas; Nicole R. Gonzales; Anne W. Alexandrov; Andrei V. Alexandrov; May Nour; Ilana Spokoyny; Jason Mackey; Sarah Q. Collins; Kelly Silnes; Mathew E. Fink; Joey English; Nobl Barazangi; Patti L. Bratina; Jay Volpi; Chethan P.V. Rao; Laura Griffin; David Persse; James C. Grotta

doi:10.1002/ana.26816

Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units

Babak B. Navi, Ivo Bach, Alexandra L. Czap, Mengxi Wang, Jose Miguel Yamal, Asha P. Jacob, Stephanie A. Parker, Suja S. Rajan, Saad Mir, Carla Sherman, Joshua Z. Willey, Jeffrey L. Saver, Michael O. Gonzalez, Noopur Singh, William J. Jones, David Ornelas, Nicole R. Gonzales, Anne W. Alexandrov, Andrei V. Alexandrov, May NourIlana Spokoyny, Jason Mackey, Sarah Q. Collins, Kelly Silnes, Mathew E. Fink, Joey English, Nobl Barazangi, Patti L. Bratina, Jay Volpi, Chethan P.V. Rao, Laura Griffin, David Persse, James C. Grotta

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: This study was undertaken to examine averted stroke in optimized stroke systems. Methods: This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue-defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis. Results: Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue-defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue-defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13–2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12–2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue-defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution. Interpretation: In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2024;95:347–361.

Original language	English (US)
Pages (from-to)	347-361
Number of pages	15
Journal	Annals of Neurology
Volume	95
Issue number	2
DOIs	https://doi.org/10.1002/ana.26816
State	Published - Feb 2024

ASJC Scopus subject areas

Neurology
Clinical Neurology

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10.1002/ana.26816

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Navi, B. B., Bach, I., Czap, A. L., Wang, M., Yamal, J. M., Jacob, A. P., Parker, S. A., Rajan, S. S., Mir, S., Sherman, C., Willey, J. Z., Saver, J. L., Gonzalez, M. O., Singh, N., Jones, W. J., Ornelas, D., Gonzales, N. R., Alexandrov, A. W., Alexandrov, A. V., ... Grotta, J. C. (2024). Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units. Annals of Neurology, 95(2), 347-361. https://doi.org/10.1002/ana.26816

Navi, BB, Bach, I, Czap, AL, Wang, M, Yamal, JM, Jacob, AP, Parker, SA, Rajan, SS, Mir, S, Sherman, C, Willey, JZ, Saver, JL, Gonzalez, MO, Singh, N, Jones, WJ, Ornelas, D, Gonzales, NR, Alexandrov, AW, Alexandrov, AV, Nour, M, Spokoyny, I, Mackey, J, Collins, SQ, Silnes, K, Fink, ME, English, J, Barazangi, N, Bratina, PL, Volpi, J, Rao, CPV, Griffin, L, Persse, D & Grotta, JC 2024, 'Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units', Annals of Neurology, vol. 95, no. 2, pp. 347-361. https://doi.org/10.1002/ana.26816

@article{59adffc4c3014618bcf7635aab39fe68,

title = "Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units",

abstract = "Objective: This study was undertaken to examine averted stroke in optimized stroke systems. Methods: This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue-defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis. Results: Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue-defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue-defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13–2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12–2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue-defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution. Interpretation: In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2024;95:347–361.",

author = "Navi, {Babak B.} and Ivo Bach and Czap, {Alexandra L.} and Mengxi Wang and Yamal, {Jose Miguel} and Jacob, {Asha P.} and Parker, {Stephanie A.} and Rajan, {Suja S.} and Saad Mir and Carla Sherman and Willey, {Joshua Z.} and Saver, {Jeffrey L.} and Gonzalez, {Michael O.} and Noopur Singh and Jones, {William J.} and David Ornelas and Gonzales, {Nicole R.} and Alexandrov, {Anne W.} and Alexandrov, {Andrei V.} and May Nour and Ilana Spokoyny and Jason Mackey and Collins, {Sarah Q.} and Kelly Silnes and Fink, {Mathew E.} and Joey English and Nobl Barazangi and Bratina, {Patti L.} and Jay Volpi and Rao, {Chethan P.V.} and Laura Griffin and David Persse and Grotta, {James C.}",

note = "Publisher Copyright: {\textcopyright} 2023 American Neurological Association.",

year = "2024",

month = feb,

doi = "10.1002/ana.26816",

language = "English (US)",

volume = "95",

pages = "347--361",

journal = "Annals of Neurology",

issn = "0364-5134",

publisher = "Wiley",

number = "2",

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TY - JOUR

T1 - Strokes Averted by Intravenous Thrombolysis

T2 - A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units

AU - Navi, Babak B.

AU - Bach, Ivo

AU - Czap, Alexandra L.

AU - Wang, Mengxi

AU - Yamal, Jose Miguel

AU - Jacob, Asha P.

AU - Parker, Stephanie A.

AU - Rajan, Suja S.

AU - Mir, Saad

AU - Sherman, Carla

AU - Willey, Joshua Z.

AU - Saver, Jeffrey L.

AU - Gonzalez, Michael O.

AU - Singh, Noopur

AU - Jones, William J.

AU - Ornelas, David

AU - Gonzales, Nicole R.

AU - Alexandrov, Anne W.

AU - Alexandrov, Andrei V.

AU - Nour, May

AU - Spokoyny, Ilana

AU - Mackey, Jason

AU - Collins, Sarah Q.

AU - Silnes, Kelly

AU - Fink, Mathew E.

AU - English, Joey

AU - Barazangi, Nobl

AU - Bratina, Patti L.

AU - Volpi, Jay

AU - Rao, Chethan P.V.

AU - Griffin, Laura

AU - Persse, David

AU - Grotta, James C.

PY - 2024/2

Y1 - 2024/2

N2 - Objective: This study was undertaken to examine averted stroke in optimized stroke systems. Methods: This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue-defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis. Results: Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue-defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue-defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13–2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12–2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue-defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution. Interpretation: In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2024;95:347–361.

AB - Objective: This study was undertaken to examine averted stroke in optimized stroke systems. Methods: This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue-defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis. Results: Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue-defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue-defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13–2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12–2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue-defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution. Interpretation: In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2024;95:347–361.

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DO - 10.1002/ana.26816

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JO - Annals of Neurology

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Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units

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