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Journal of the Korean Neurological Association 2007;25(3): 298-303.
허혈성 뇌졸중 환자에서 혈전용해제 치료의 예후 인자
윤병남, 나정호
인하대학교 의과대학 신경과학교실
Prognostic Factors of Thrombolytic Therapy in Ischemic Stroke
Byung-Nam Yoon
Department of Neurology, College of medicine, Inha University, Incheon, Korea
Abstract
Background: The intravenous thrombolysis is a well established treatment of acute ischemic stroke. However, baseline prognostic factors were poorly identified by previous studies.
Methods: From January 2001 to May 2006, prospective data of 121 patients treated with intravenous tissue plasminogen activator (tPA) were collected. The clinical, radiologic, transcranial Dopper (TCD) and laboratory finding were evaluated. Clinical assessment was done by National Institutes of Health Stroke Scale (NIHSS) for one week, and by modified Rankin Scale (mRS) at baseline for three months. Early improvement was defined as the complete resolution of the neurological deficit or an improvement of ≥ 4 points by NIHSS within 24 hours, and good outcome as mRS score of ≤ 2 at three months. We assessed the possible relationship of the factors with early improvement and good outcome, and also analyzed the correlation of TCD grade with NIHSS score.
Results: On univariate analysis, younger age, absence of abnormal CT findings (hyperdense middle cerebral artery sign [HMCAS], focal hypodensity > 33% of total MCA territory) were significantly associated with early improvement. Good outcome was associated with younger age, lower levels of baseline NIHSS score, mean blood pressure, fasting glucose, lipoprotein (a), and normal CT finding. Multivariate analysis revealed age < 66 years and no HMCAS as independent predictors of early improvement. Thrombolysis in brain ischemia grade by TCD monitoring significantly correlated with NIHSS score for 24 hours.
Conclusions: These results suggest that younger age and normal CT findings are important prognostic factors of acute thrombolytic therapy. KeyWords:Tissue plasminogen activator, Acute stroke, Prognosis, Transcranial doppler (TCD)