Miroslav Brozman, Tibor Göbö, Andrea Petrovičová, Gabriel Hajaš, Agáta Frišová, Adriana Filipová, Marta Miklošková, Monika Virágová, Mária Raisová, Pavol Varga, Roman Pétery, Jeanette Kvasňovská, Martin Halaj, Alexander Ruttkay
Introduction and Purpose: Intravenous rt-PA thrombolysis is the only approved and effective treatment for acute ischemic stroke within the first 3 hours after symptom onset. However, despite demonstrated efficacy and acceptable safety, despite endorsement by accredited medical organizations it has been estimated, that only 1 - 2 % of patients with acute ischemic stroke receive thrombolytic therapy. Especially, fears of excessive bleeding and the perception that only a small percentage of patient population is eligible for IV rt-PA treatment negatively influence the decision of thrombolysis. The goal of the study was to analyze our experience with intravenous rt-PA thrombolysis which became the standard method of therapy in the emergency management of patients with ischemic stroke in the region of Nitra. Methods: We retrospectively analyzed data from a prospective singlecenter study between 1998 and 2005. During this period we consecutively performed 119 intravenous rt-PA thrombolytic efforts in 118 patients with acute ischemic stroke. In the group of treated patients 42 % were women; mean age was 63.2 years; mean initial NIHSS was 14.02; mean time interval between onset of symptoms and treatment was 161 min; mean rt-PA dosis was 0.71 mg/kg/patient. Results: At discharge 29.4 % of treated patients were without deficit or with only mild symptoms (mRS 0 - 1), 42 % of patients were in good clinical condition (mRS 0 - 2), 36 % of patients with moderate and moderately severe deficits (mRS 3 - 4) and 8.4 % of patients were with severe deficits (mRS 5). Mortality reached 15.1 %, but only 5.9 % from hemorrhagic transformation of their initial ischemic stroke. Conclusion: Our experience with intravenous rt-PA thrombolysis of acute ischemic strokes shows that thrombolysis can be successful in clinical practice when performed according to standard diagnostic and therapeutic criteria. Cooperation of all components of emergent medical care is crucial, especially emergent transportation, emergency units with all necessary laboratory tests, CT unit and intensive care neurological (stroke) unit.