Intravenous rt-PA Fibrinolytic Therapy in Acute Carotid Territory Ischemic Stroke with Severe Neurologic Deficits : The Implication of Arterial Recanalization for Stroke Outcome

J Korean Neurol Assoc > Volume 21(1); 2003 > Article

Journal of the Korean Neurological Association 2003;21(1): 1-6.

중증의 신경학적 증상을 동반하는 급성 경동맥계 허혈성 뇌졸중의 정맥내 rt-PA 혈전용해치료:뇌졸중 성과에 대한 혈관 재개통의 의의

장대일 , 윤성상 신원철 정경천

경희대학교 의과대학 신경과학교실

Intravenous rt-PA Fibrinolytic Therapy in Acute Carotid Territory Ischemic Stroke with Severe Neurologic Deficits : The Implication of Arterial Recanalization for Stroke Outcome

Dae Il Chang

Department of Neurology, Kyung Hee University, College of Medicine

Abstract

"Background : Our previous pilot study demonstrated that intravenous recombinant tissue plasminogen activator(rt-PA) fibrinolytic therapy was effective in treatment of effects of acute ischemic stroke within 3 hours of onset. We stud-ied whether rt-PA was effective and safe in patients with acute carotid artery territory ischemic stroke with severe neu-rologic deficits (National Institute of Health Stroke Scale (NIHSS) score >14 points) and whether arterial recanalization after rt-PA infusion influenced the initial neurologic improvements within 24 hours and the stroke outcome at 3 months. Methods : Twenty eligible patients had pre- and post-treatment computed tomogram and pre-treatment magnetic reso-nance angiogram. Fourteen patients had post-treatment magnetic resonance angiogram at 24 hours after stroke onset. Endpoints examined included initial neurological improvement at 2 and 24 hours by NIHSS and clinical stroke outcome at 3 months by a modified Rankin scale and the effect of recanalization on initial improvement and stroke outcome. Results : Out of 20 patients, 9 patients (45%) showed initial improvement at 2 hours and 10 patients (50%) at 24 hours. Five patients (25%) had intracranial hemorrhages (symptomatic; 2). Twelve patients (60%) showed good clinical stroke outcome at 3 months. Complete or partial recanalization was observed in 11 patients (55%) at 24 hours after stroke onset. Recanalization correlated with good initial improvement and stroke outcome (p<0.05 and <0.05). Conclusions : Recanalization may have an association with good clinical outcome after rt-PA infusion within 3 hours of stroke onset in patients with acute carotid artery territory stroke with severe neurologic deficits.Key Words : Cerebral ischemia, Thrombolytic therapy, Recanalization, Plasminogen activator, Tissue-type, Stroke out-come"