Intravenous r-tPA Therapy in Acute Ischemic Stroke: The Implication of Immediate Neurological Improvement for the Long-term Outcome.
- Author:
Jong Seok BAE
1
;
Kyung Ho YU
;
Dae Hoon KIM
;
Sung Hee WHANG
;
Hyeong Chul KIM
;
Sung Min KIM
;
Hyeo Il MA
;
Seung Chul JUNG
;
Byung Chul LEE
Author Information
1. Department of Neurology, Hallym University College of Medicine.
- Publication Type:Original Article
- Keywords:
Tissue plasminogen activator;
Thrombolytic therapy;
Treatment outcome;
Cerebral infarction
- MeSH:
Brain;
Cerebral Infarction;
Humans;
Intracranial Hemorrhages;
Korea;
National Institute of Neurological Disorders and Stroke;
National Institutes of Health (U.S.);
Needles;
Risk Factors;
Stroke*;
Thrombolytic Therapy;
Tissue Plasminogen Activator;
Treatment Outcome
- From:Journal of the Korean Neurological Association
2001;19(4):364-369
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Intravenous recombinant tissue plasminogen activator (r-tPA) infusion is the only established treatment for acute ischemic stroke so far. We explored whether the demonstrated efficacy of r-tPA could be applied to communi-ty-based hospitals in Korea and whether the immediate improvements after r-tPA infusion had any predicting value for long-term outcomes. METHODS:Twenty-six patients (mean age, 69; 46% female) with acute ischemic stroke were treated with r-tPA, abiding by the National Institute of Neurological Disorders and Stroke (NINDS) protocol. The Neurological status was measured with the National Institutes of Health Stroke Scale (NIHSS) at baseline, at 1 hour after r-tPA , at 24 hours, and at 7 days and the functional outcome was evaluated with the modified Rankin scale (mRS) and Barthel Index at 90 days after stroke. RESULTS: Of 26 patients, 16 (62%) made full recovery or became independent, 4 (15%) had severe physical disability, and 6 (23%) patients died. Three patients (11.5%) had intracranial hemorrhage (asymptomatic, 2; symptomatic, 1). There were no significant differences in age, sex, risk factors, baseline NIHSS scores, hemorrhagic complication, initial brain CT abnormalities, and onset to needle time between good (full recovery or mRS 0-2) and poor groups (mRS 3-5 or death) at day 90, except for the improvement of NIHSS examined at 1 hour after r-tPA (repeated measured ANOVA test, p<0.01). CONCLUSIONS The NINDS r-tPA protocol is feasible in the community-based hospitals in Korea with the safety and efficacy comparable to the results of NINDS r-tPA trials. In addition, we suggest that the immediate neurological improvement after r-tPA be a predictor for favorable long-term outcomes. (J Korean Neurol Assoc 19(4):364~369, 2001)
