Community-based thrombolytic therapy of acute ischemic stroke in Helsinki.
OBJECTIVE
Thrombolysis with alteplase is used in acute ischemic stroke within 3 hours after symptom onset in many stroke centers, but experience remains limited in Europe.


METHODS
Using eligibility and management criteria similar to those published by the American Heart Association, we treated 75 consecutive patients aged 21 to 83 years (mean age, 63.6 years; median Scandinavian Stroke Scale score, 32/58) with hemispheric infarction with alteplase in 1998-2001. Their neuroradiological findings (ischemic and hemorrhagic changes) and functional outcome at 3 months were evaluated.


RESULTS
Sixty-one percent of the patients had recovered functional independence (Barthel Index 95 to 100) at the 3-month follow-up. On the modified Rankin Scale (mRS), 37% (28/75) of patients had no or minimal symptoms (mRS 0 to 1), while 17% (13/75) remained dependent (mRS 4 to 5) and 5% (4/75) died. Cerebral parenchymal hematomas occurred in 8% (6/75) and hemorrhagic transformation in 8% (6/75) of the patients. Low initial diastolic blood pressure and administration of intravenous antihypertensive medication were associated with unfavorable outcome (mRS 3 to 6).


CONCLUSIONS
We conclude that our management protocol for thrombolytic therapy is safe. These rates of functional outcome, case fatality, and hemorrhagic cerebral events compare favorably with those of other published series of stroke thrombolysis with similar time windows and management guidelines. Associations between blood pressure and its treatment during thrombolysis with functional outcome deserve further analysis.
Department of Neurology, Biomedicum Helsinki, Helsinki University Central Hospital, PO Box 700, Helsinki, FIN-00029 HUS, Finland. perttu.lindsberg@hus.fi
Perttu J
PJ
Lindsberg
Lauri
L
Soinne
Risto O
RO
Roine
Oili
O
Salonen
Turgut
T
Tatlisumak
Mikko
M
Kallela
Olli
O
Häppölä
Marjaana
M
Tiainen
Elena
E
Haapaniemi
Markku
M
Kuisma
Markku
M
Kaste
D000046:Academic Medical Centers; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D003151:Community Health Centers; D003710:Demography; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005387:Finland; D006801:Humans; D007741:Labetalol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020127:Recovery of Function / Q000187:drug effects; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D007741:Labetalol