{"id":6053,"date":"2005-07-12T00:00:00","date_gmt":"2005-07-12T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/the-impact-of-lesion-side-on-acute-stroke-treatment\/"},"modified":"2023-06-14T19:43:07","modified_gmt":"2023-06-14T23:43:07","slug":"the-impact-of-lesion-side-on-acute-stroke-treatment","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/the-impact-of-lesion-side-on-acute-stroke-treatment\/","title":{"rendered":"The impact of lesion side on acute stroke treatment"},"content":{"rendered":"<p><strong>Background<\/strong> &#x2014; Only a small percentage of patients with acute stroke are treated with recombinant tissue plasminogen activator (rt-PA).<\/p>\n<p><strong>Objective<\/strong> &#x2014; To investigate why patients with right-hemisphere strokes seem at high risk of not receiving rt-PA.<\/p>\n<p><strong>Methods<\/strong> &#x2014; This study includes two phases. Phase 1: the authors compared demographic, clinical, and outcome measures between patients with right- and left-hemisphere strokes in the rt-PA Registry of Southwestern Ontario (RSWO); Phase 2: the authors tested the hypotheses generated in Phase 1 using the Registry of the Canadian Stroke Network (RCSN). A multiple logistic analysis was applied to detect independent predictors of rt-PA administration.<\/p>\n<p><strong>Results<\/strong> &#x2014; Phase 1: of 179 rt-PA-treated patients, 39% had right-hemisphere syndrome. Patients with right-hemisphere strokes had a longer hospital stay (15 vs 9 days; p = 0.03). Phase 2: of 990 stroke patients in the RCSN, 505 (51%) had a right- and 485 (49%) a left-hemisphere syndrome. Of 110 rt-PA-treated patients, 37 (34%) had a right-hemisphere syndrome (p = 0.0001). Negative independent predictors of rt-PA administration were right-hemisphere stroke (OR, 0.55; CI: 0.31 to 0.96; p = 0.037), onset-to-emergency department time (OR, 0.99; CI 0.98 to 0.99; p = 0.04), and CNS score (OR, 0.78; CI 0.71 to 0.86; p &lt; 0.0001). Neglect predicted rt-PA administration (OR, 2.32; CI 1.29 to 4.16; p = 0.004).<\/p>\n<p><strong>Conclusions<\/strong> &#x2014; Patients with right-hemisphere strokes are 45% less likely to be treated with recombinant tissue plasminogen activator (rt-PA) compared to patients with left-hemisphere strokes. The presence of neglect confers a twofold increased likelihood of rt-PA administration. Prehospital delay and lack of standardized scores for the neglect syndrome may limit accessibility of patients with right-hemisphere stroke to thrombolysis.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; Only a small percentage of patients with acute stroke are treated with recombinant tissue plasminogen activator (rt-PA). Objective &#x2014; To investigate why patients with right-hemisphere strokes seem at high risk of not receiving rt-PA. Methods &#x2014; This study includes two phases. Phase 1: the authors compared demographic, clinical, and outcome measures between patients [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[40,62],"migration-helper-qa-sample-set":[],"class_list":["post-6053","journal_article","type-journal_article","status-publish","hentry","topic-cardiovascular-disease","topic-health-services-research"],"acf":{"citation":"Di Legge S, Fang J, Saposnik G, Hachinski V. <em>Neurology<\/em>. 2005; 65(1):81-6.","source_url":"","ices_scientist":[1365],"site":[6733],"research_program":[6742],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"C909AC4E-9027-47FC-B453-7282A40AA005","sitecore_item_name":"The-impact-of-lesion-side-on-acute-stroke-treatment","sitecore_field_values":"{\n  \"Title\": \"The impact of lesion side on acute stroke treatment\",\n  \"Short title\": \"The impact of lesion side on acute\",\n  \"Citation\": \"<p>Di Legge S, Fang J, Saposnik G, Hachinski V. <em>Neurology<\/em>. 2005; 65(1):81-6.<\/p>\",\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash; Only a small percentage of patients with acute stroke are treated with recombinant tissue plasminogen activator (rt-PA).<\/p>rn<p><strong>Objective<\/strong> &mdash; To investigate why patients with right-hemisphere strokes seem at high risk of not receiving rt-PA.<\/p>rn<p><strong>Methods<\/strong> &mdash; This study includes two phases. Phase 1: the authors compared demographic, clinical, and outcome measures between patients with right- and left-hemisphere strokes in the rt-PA Registry of Southwestern Ontario (RSWO); Phase 2: the authors tested the hypotheses generated in Phase 1 using the Registry of the Canadian Stroke Network (RCSN). A multiple logistic analysis was applied to detect independent predictors of rt-PA administration.<\/p>rn<p><strong>Results<\/strong> &mdash; Phase 1: of 179 rt-PA-treated patients, 39% had right-hemisphere syndrome. Patients with right-hemisphere strokes had a longer hospital stay (15 vs 9 days; p = 0.03). Phase 2: of 990 stroke patients in the RCSN, 505 (51%) had a right- and 485 (49%) a left-hemisphere syndrome. Of 110 rt-PA-treated patients, 37 (34%) had a right-hemisphere syndrome (p = 0.0001). Negative independent predictors of rt-PA administration were right-hemisphere stroke (OR, 0.55; CI: 0.31 to 0.96; p = 0.037), onset-to-emergency department time (OR, 0.99; CI 0.98 to 0.99; p = 0.04), and CNS score (OR, 0.78; CI 0.71 to 0.86; p &lt; 0.0001). Neglect predicted rt-PA administration (OR, 2.32; CI 1.29 to 4.16; p = 0.004).<\/p>rn<p><strong>Conclusions<\/strong> &mdash; Patients with right-hemisphere strokes are 45% less likely to be treated with recombinant tissue plasminogen activator (rt-PA) compared to patients with left-hemisphere strokes. The presence of neglect confers a twofold increased likelihood of rt-PA administration. Prehospital delay and lack of standardized scores for the neglect syndrome may limit accessibility of patients with right-hemisphere stroke to thrombolysis.<\/p>\",\n  \"Keywords\": \"{E35EA75E-2C35-42CC-90D1-00302436CB1C}|{A39C5396-16B7-4369-B0F9-31F6E91E46FC}\",\n  \"Research Programs\": \"{BEC72DE0-BA8C-42B8-ACE5-EE29FFB2CB3B}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{9F556094-95ED-4001-9E45-0094CCC54588}\",\n  \"Posted Date\": \"20050712T000000\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2005\/January\/The-impact-of-lesion-side-on-acute-stroke-treatment"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | The impact of lesion side on acute stroke treatment<\/title>\n<meta name=\"description\" content=\"Background &#x2014; Only a small percentage of patients with acute stroke are treated with recombinant tissue plasminogen activator (rt-PA).\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/the-impact-of-lesion-side-on-acute-stroke-treatment\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | The impact of lesion side on acute stroke treatment\" \/>\n<meta property=\"og:description\" content=\"Background &#x2014; 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