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From the Department of Clinical Neurological Sciences (Drs. Di Legge, Saposnik, and Hachinski), London Health Science Centre, University of Western Ontario; and Institute for Clinical Evaluative Sciences (ICES) (Dr. Fang), Toronto, Ontario, Canada.
Address correspondence and reprint requests to Dr. Silvia Di Legge, Department of Clinical Neurological Sciences, University of Western Ontario, 339 Windermere Road, London, ON, Canada N6A 5A5; e-mail: sdilegge{at}uwo.ca
Background: Only a small percentage of patients with acute stroke are treated with recombinant tissue plasminogen activator (rt-PA).
Objective: To investigate why patients with right-hemisphere strokes seem at high risk of not receiving rt-PA.
Methods: 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.
Results: 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 < 0.0001). Neglect predicted rt-PA administration (OR, 2.32; CI 1.29 to 4.16; p = 0.004).
Conclusions: 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.
Supported in part by a grant of the Heart Stroke Foundation of Canada (HSFC) and the Canadian Institute for Health Research (CIHR) (S.D. and G.S). The grant was obtained based on competitive applications following publication of grant advertisements. The investigators acted as the sponsors of the study. The CIHR and the HSFC had no input on the design, access to the data, analyses, interpretation, or publication of the study.
The authors have nothing to disclose.
Received September 6, 2004. Accepted in final form March 25, 2005.
This article has been cited by other articles:
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  S. D. Legge, G. Saposnik, Y. Nilanont, and V. Hachinski Neglecting the Difference: Does Right or Left Matter in Stroke Outcome After Thrombolysis? Stroke, August 1, 2006; 37(8): 2066 - 2069. [Abstract] [Full Text] [PDF]
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S. T. Engelter, M. Gostynski, S. Papa, M. Frei, C. Born, V. Ajdacic-Gross, F. Gutzwiller, and P. A. Lyrer Epidemiology of Aphasia Attributable to First Ischemic Stroke: Incidence, Severity, Fluency, Etiology, and Thrombolysis Stroke, June 1, 2006; 37(6): 1379 - 1384. [Abstract] [Full Text] [PDF]
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 Some Stroke Patients Are Easy to Neglect Journal Watch Psychiatry, September 21, 2005; 2005(921): 6 - 6. [Full Text]
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