Intravenous thrombolysis for acute ischemic stroke--our experiences

Area of Science:

• Neurology
• Pharmacology

Background:

• Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the sole pharmacological intervention for acute ischemic stroke.
• Timely administration of rt-PA is crucial for improving patient outcomes.

Purpose of the Study:

• To compare the efficacy and safety of intravenous rt-PA in acute ischemic stroke patients treated within 3 hours versus those treated after 3 hours.
• To evaluate the impact of rt-PA on functional outcomes, symptomatic intracranial hemorrhage, and mortality.

Main Methods:

• A comparative study involving 71 patients receiving intravenous rt-PA within 3 hours and 71 control patients treated after 3 hours.
• Primary endpoint: modified Rankin scale (mRS) at 90 days (favorable vs. unfavorable).
• Secondary endpoints: symptomatic intracerebral hemorrhage and 3-month mortality.

Main Results:

• A significantly higher proportion of patients achieved a favorable outcome in the rt-PA treated group (64.79%) compared to the control group (22.54%; p = 0.0001).
• Patients treated with rt-PA showed a greater likelihood of minimal or no deficit at 90 days.
• Symptomatic intracranial hemorrhage occurred in 1 patient, and asymptomatic hemorrhage in 2 patients within the rt-PA treated group.

Conclusions:

• Intravenous rt-PA administration within 3 hours of acute ischemic stroke onset is safe and effective in improving functional outcomes.
• The study demonstrates successful implementation of an acute stroke thrombolysis service adhering to treatment guidelines.
• Thrombolytic therapy with rt-PA is recommended for selected acute ischemic stroke populations.