Intravenous thrombolysis for acute ischemic stroke in Greece

the Safe Implementation of Thrombolysis in Stroke registry 15-year experience

Georgios Tsivgoulis, Odysseas Kargiotis, Jobst Rudolf, Apostolos Komnos, Antonios Tavernarakis, Theodoros Karapanayiotides, John Ellul, Aristeidis H. Katsanos, Sotirios Giannopoulos, Maria Gryllia, Apostolos Safouris, Panagiotis Papamichalis, Konstantinos Vadikolias, Panayiotis Mitsias, Georgios Hadjigeorgiou

Research output: Contribution to journalArticle

Abstract

Background: Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset. Methods: All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk factors, baseline stroke severity [defined using National Institutes of Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were recorded. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 3-month mortality rates. The efficacy outcomes evaluated a reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month favorable functional outcome [FFO; modified Rankin scale (mRS) scores of 0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety and efficacy outcomes were assessed comparatively with previously published data from SITS national and international registries. Results: A total of 523 AIS patients were treated with IVT in 12 Greek centers participating in the SITS-ISTR during the study period (mean age 62.4 ± 12.7; 34.6% women; median baseline NIHSS score: 11 points; median OTT: 150 min). The rates of sICH were 1.4%, 2.3%, and 3.8% according to the SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5 (IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were 66.5%, 55.6% and 7.9%. All safety and efficacy outcomes were comparable with available data from SITS-ISTR in other European countries. Conclusions: Our study underscores the safety and efficacy of IVT for AIS in Greece. Additional action is necessary in order to increase the availability of IVT in the Greek population and to include more centers in the SITS-ISTR.

Original languageEnglish (US)
JournalTherapeutic Advances in Neurological Disorders
Volume11
DOIs
StatePublished - Jan 1 2018

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Greece
Registries
Stroke
National Institutes of Health (U.S.)
Safety
Intracranial Hemorrhages
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid
National Institute of Neurological Disorders and Stroke
Mortality

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Neurology
  • Clinical Neurology

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Intravenous thrombolysis for acute ischemic stroke in Greece : the Safe Implementation of Thrombolysis in Stroke registry 15-year experience. / Tsivgoulis, Georgios; Kargiotis, Odysseas; Rudolf, Jobst; Komnos, Apostolos; Tavernarakis, Antonios; Karapanayiotides, Theodoros; Ellul, John; Katsanos, Aristeidis H.; Giannopoulos, Sotirios; Gryllia, Maria; Safouris, Apostolos; Papamichalis, Panagiotis; Vadikolias, Konstantinos; Mitsias, Panayiotis; Hadjigeorgiou, Georgios.

In: Therapeutic Advances in Neurological Disorders, Vol. 11, 01.01.2018.

Research output: Contribution to journalArticle

Tsivgoulis, G, Kargiotis, O, Rudolf, J, Komnos, A, Tavernarakis, A, Karapanayiotides, T, Ellul, J, Katsanos, AH, Giannopoulos, S, Gryllia, M, Safouris, A, Papamichalis, P, Vadikolias, K, Mitsias, P & Hadjigeorgiou, G 2018, 'Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience', Therapeutic Advances in Neurological Disorders, vol. 11. https://doi.org/10.1177/1756286418783578
Tsivgoulis, Georgios ; Kargiotis, Odysseas ; Rudolf, Jobst ; Komnos, Apostolos ; Tavernarakis, Antonios ; Karapanayiotides, Theodoros ; Ellul, John ; Katsanos, Aristeidis H. ; Giannopoulos, Sotirios ; Gryllia, Maria ; Safouris, Apostolos ; Papamichalis, Panagiotis ; Vadikolias, Konstantinos ; Mitsias, Panayiotis ; Hadjigeorgiou, Georgios. / Intravenous thrombolysis for acute ischemic stroke in Greece : the Safe Implementation of Thrombolysis in Stroke registry 15-year experience. In: Therapeutic Advances in Neurological Disorders. 2018 ; Vol. 11.
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abstract = "Background: Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset. Methods: All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk factors, baseline stroke severity [defined using National Institutes of Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were recorded. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 3-month mortality rates. The efficacy outcomes evaluated a reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month favorable functional outcome [FFO; modified Rankin scale (mRS) scores of 0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety and efficacy outcomes were assessed comparatively with previously published data from SITS national and international registries. Results: A total of 523 AIS patients were treated with IVT in 12 Greek centers participating in the SITS-ISTR during the study period (mean age 62.4 ± 12.7; 34.6{\%} women; median baseline NIHSS score: 11 points; median OTT: 150 min). The rates of sICH were 1.4{\%}, 2.3{\%}, and 3.8{\%} according to the SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5 (IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were 66.5{\%}, 55.6{\%} and 7.9{\%}. All safety and efficacy outcomes were comparable with available data from SITS-ISTR in other European countries. Conclusions: Our study underscores the safety and efficacy of IVT for AIS in Greece. Additional action is necessary in order to increase the availability of IVT in the Greek population and to include more centers in the SITS-ISTR.",
author = "Georgios Tsivgoulis and Odysseas Kargiotis and Jobst Rudolf and Apostolos Komnos and Antonios Tavernarakis and Theodoros Karapanayiotides and John Ellul and Katsanos, {Aristeidis H.} and Sotirios Giannopoulos and Maria Gryllia and Apostolos Safouris and Panagiotis Papamichalis and Konstantinos Vadikolias and Panayiotis Mitsias and Georgios Hadjigeorgiou",
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T1 - Intravenous thrombolysis for acute ischemic stroke in Greece

T2 - the Safe Implementation of Thrombolysis in Stroke registry 15-year experience

AU - Tsivgoulis, Georgios

AU - Kargiotis, Odysseas

AU - Rudolf, Jobst

AU - Komnos, Apostolos

AU - Tavernarakis, Antonios

AU - Karapanayiotides, Theodoros

AU - Ellul, John

AU - Katsanos, Aristeidis H.

AU - Giannopoulos, Sotirios

AU - Gryllia, Maria

AU - Safouris, Apostolos

AU - Papamichalis, Panagiotis

AU - Vadikolias, Konstantinos

AU - Mitsias, Panayiotis

AU - Hadjigeorgiou, Georgios

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset. Methods: All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk factors, baseline stroke severity [defined using National Institutes of Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were recorded. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 3-month mortality rates. The efficacy outcomes evaluated a reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month favorable functional outcome [FFO; modified Rankin scale (mRS) scores of 0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety and efficacy outcomes were assessed comparatively with previously published data from SITS national and international registries. Results: A total of 523 AIS patients were treated with IVT in 12 Greek centers participating in the SITS-ISTR during the study period (mean age 62.4 ± 12.7; 34.6% women; median baseline NIHSS score: 11 points; median OTT: 150 min). The rates of sICH were 1.4%, 2.3%, and 3.8% according to the SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5 (IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were 66.5%, 55.6% and 7.9%. All safety and efficacy outcomes were comparable with available data from SITS-ISTR in other European countries. Conclusions: Our study underscores the safety and efficacy of IVT for AIS in Greece. Additional action is necessary in order to increase the availability of IVT in the Greek population and to include more centers in the SITS-ISTR.

AB - Background: Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset. Methods: All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk factors, baseline stroke severity [defined using National Institutes of Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were recorded. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 3-month mortality rates. The efficacy outcomes evaluated a reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month favorable functional outcome [FFO; modified Rankin scale (mRS) scores of 0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety and efficacy outcomes were assessed comparatively with previously published data from SITS national and international registries. Results: A total of 523 AIS patients were treated with IVT in 12 Greek centers participating in the SITS-ISTR during the study period (mean age 62.4 ± 12.7; 34.6% women; median baseline NIHSS score: 11 points; median OTT: 150 min). The rates of sICH were 1.4%, 2.3%, and 3.8% according to the SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5 (IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were 66.5%, 55.6% and 7.9%. All safety and efficacy outcomes were comparable with available data from SITS-ISTR in other European countries. Conclusions: Our study underscores the safety and efficacy of IVT for AIS in Greece. Additional action is necessary in order to increase the availability of IVT in the Greek population and to include more centers in the SITS-ISTR.

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