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Early Profiles of Clinical Evolution after Intravenous Thrombolysis in an Unselected Stroke Population
  1. Montserrat G Delgado1,*,
  2. Patrik Michel2,
  3. Manuel Naves1,
  4. Philippe Maeder2,
  5. Marc Reichhart2,
  6. Max Wintermark3,
  7. Julien Bogousslavsky4
  1. 1 Hospital Universitario Central de Asturias, Spain;
  2. 2 Centre Hospitalier Universitaire Vaudois, Switzerland;
  3. 3 University of California, Spain;
  4. 4 Genolier Swiss Medical Network, Switzerland
  1. Correspondence to: Montserrat G Delgado, Hospital Central de Asturias, Julián Clavería s/n, Oviedo, 33006, Spain; mglezdelgado{at}yahoo.es

Abstract

Background: Intravenous (IV) recombinant tissular plasminogen activator (rt-PA) is the only approved pharmacological treatment for acute ischemic stroke. We aimed to analyze potential causes of the variable effect on early course and late outcome.

Methods and results: 136 patients (42% women, 58% men) treated with IV rt-PA within 3 hours of stroke onset in an acute stroke unit over a three-year period, were included. Early clinical profiles of evolution at 48 hours were divided into clinical improvement (CI) (decrease >4 points in the National Institute of Health Stroke Scale (NIHSS)); clinical worsening (CW) (increase >4 points NIHSS); clinical worsening after initial improvement (CWFI) (variations of >4 points in the NIHSS). Patients with clinical stability (no NIHSS modification or < 4 points) were excluded. Our patients showed in 66.9% CI, 13.2% CW 8.1 % CWFI and 11.8% remained stable. Female sex, no hyperlipemia and peripheral arterial disease were associated with CW. Male sex and smoking were associated with CI. Absence of arterial occlusion on admission (28.4%) and arterial recanalization at 24 hours were associated with CI. Main causes of clinical deterioration included symptomatic intracranial haemorrhage (sICH), persistent occlusion and cerebral edema. 23.5% developed ICH, 6.6% of which had sICH. At 3 months, 15.5% had died. Mortality was increased in CW, mainly related to sICH and cerebral edema. Outcome of CWFI was intermediate between CW and CI.

Conclusions: Early clinical profiles of evolution in thrombolyzed patients vary considerably. Even with CI it is critical to maintain vessel permeability to avoid subsequent CW.

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