Intravenous thrombolysis for acute ischemic stroke--our experiences

Intravenous (i.v.) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the only available pharmacological therapy to improve the outcome of acute ischemic stroke. We compared 71 patients presenting with ischaemic stroke and given intravenous rt-PA (0.9 mg/kg total dose) within 3 h with 71 patients who present to the hospital more than 3 hours after stroke symptom onset. The primary endpoint was the modified Rankin scale (mRS) at 90 days, dichotomised for favourable and unfavourable (score 2-6). Outcome measures were symptomatic intracerebral haemorrhage within 36 h (haemorrhage associated with National Institutes of Health Stroke Scale [NIHSS] > or = 4 points deterioration), and mortality at 3 months. More patients had favourable outcome with the rt-PA-treated group than with the control group (64.79% vs. 22.54%; p = 0.0001). The greater proportion of patients left with minimal or no deficit 90 days after rt-PA treatment, as compared with the control group. In the treated group symptomatic intracranial hemorrhage occurred in 1 patient who recovered to a level of functional independence, and asymptomatic intracranial hemorrhage was observed in 2 patients. Our experience of an acute stroke thrombolysis service shows that we are able to provide this treatment safely and in accordance with established treatment guidelines. We recommend thrombolytic treatment in acute ischemic stroke for selected population.