[Feasibility of stroke thrombolysis at Pau Hospital, France].
BACKGROUND
Stroke is the most common cause of permanent disability in Europe and is a major public health problem. A recent significant therapeutic advance is the administration of recombinant tissue plasminogen activator (rtPA) for cerebral infarcts within three hours of symptom onset. French guidelines limit its use to patients in specialized stroke units. There is only one stroke unit in the region of Aquitaine, in Bordeaux, 200 km from Pau and too far to transfer patients within the necessary time. With the collaboration of our colleagues in Bordeaux we decided to assess whether stroke thrombolysis could be feasibly and safely administered in our district general hospital.


METHODS
From September 2004 through August 2005, eligible patients received rtPA treatment in the emergency department. The National Institutes of Health Stroke Scale (NIHSS) was administered at admission, immediately after treatment, and 24 hours later. In January 2006, a prospective follow-up assessed the NIHSS, Modified Rankin Scale (MRS) and Barthel Index Score (BIS) for all subjects still alive and collected data about those who had died.


RESULTS
In all, 553 patients were admitted for stroke: 306 had cerebral infarcts and 25 (8.1%) were treated by intravenous thrombolysis. The mean age of the patients who received thrombolysis was 67 years (range: 33-80), and the sex ratio was 4/1 (20 men and 5 women). Mean delay from symptom onset to treatment was 150 min (range 105-180). The median NIHSS score was 13 (range 8-22) at admission, 10 (range 0-22) after treatment, and 7 the next day (range 0-22). Two patients (8%) died during the acute phase. On January 2006, after a median follow-up of 11.6 months (range: 6-16), 18 (72%) patients were still alive: 13 (52%) with good outcomes (MRS, 0-1) and 3 severely disabled and institutionalized (BIS, 0-50).


CONCLUSIONS
Our results show that thrombolysis is possible in Pau. The population in our catchment area has a good proportion of stroke patients eligible for thrombolytic treatment. Outcomes and mortality rate are consistent with experience elsewhere. The creation of a stroke unit should help improve prognosis while complying with management guidelines.
Barroso
Bruno
B
Service de neurologie, Hôpital François Mitterrand, Pau Université Cedex. bruno.barroso@ch-pau.fr
Larrieu
Jean-Marc
JM
Morisset
Christophe
C
Carlier
Philippe
P
Bersani
Daniel
D
Dakar
Alexandre
A
Lagabrielle
Jean-François
JF
Larribau
Edouard
E
Lippa
Alain
A
Mangon
Hervé
H
Montaut
Nicole
N
Rouanet
François
F
D000328:Adult; D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator