BASELINE STROKE SEVERITY BEFORE AND AFTER INTRAVENOUS THROMBOLYSIS

Abstract

Abstract

Introduction

Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke. Recanalization strategies such as intravenous recombinant tissue-type plasminogen activator (rt-PA), attempt to establish revascularization so that cells in the ischemic penumbra can be rescued before irreversible injury occurs. The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit.

Aim

To evaluate and compare the baseline stroke severity-NIHSS score in acute stroke patients before and after application of intravenous thrombolysis.

Material and methods

We made a retrospective analysis of 1058 acute stroke patients, hospitalized during a period of April 2014-February 2016, at the Department for Urgent Neurology, University Clinic of Neurology, Skopje. Of them, 27 patients met the inclusion criteria for rtPA application according the guidelines.

Results

I.v. thrombolysis was administered in 27 patients (2,5%). 9 (33,3%) patients had mild stroke (NIHSS 5-10), 11 (40,7%) patients had moderate stroke (NIHSS 10-15) and 7 (25,9%) patients had severe stroke (NIHSS > 15). After the administration of rtPA, we registered improvement on the NIHSS score in 20 patients (74%). Most of them (18-90%) were improved by 3 points on the NIHSS score (range 1-10 points). Best response to therapy had patients with mild and moderate stroke according to NIHSS scores. In unchanged condition after rtPA application were 2 patients (7,4%) with NIHSS score of 10 and 12, respectively. Worsening of the neurological deficit was registered in 1 patient (3,7%), who had initial NIHSS score of 9 and 1 hour after application of rtPA his NIHSS score increased to 12. 4 patients (14,8%) had lethal outcome. Discussion and conclusion

Our study shows the initial experience with i.v. thrombolysis in eligible patients with acute ischemic stroke. More than 70% of the thrombolysed patients improved their functional deficit after the treatment. Intravenous thrombolytic therapy with rtPA is the only approved therapy so far approved for treatment of acute ischemic stroke. Meta-analysis of the trials so far have confirmed the benefit of i.v. thrombolytic therapy in selected patients with acute ischemic stroke. All agree that the earlier the therapy is given, the results are better and the health systems should increase their percentage of stroke patients treated within 60 minutes of presentation to hospital until application of thrombolytic therapy.