Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population.
BACKGROUND
Intravenous recombinant tissular plasminogen activator (rt-PA) is the only approved pharmacological treatment for acute ischaemic stroke. The authors aimed to analyse potential causes of the variable effect on early course and late outcome.


RESULTS
136 patients (42% women, 58% men) treated with intravenous rt-PA within 3 h of stroke onset in an acute stroke unit over a 3-year period, were included. Early clinical profiles of evolution at 48 h 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. The patients showed in 66.9% CI, 13.2% CW 8.1 % CWFI and 11.8% remained stable. Female sex, no hyperlipaemia 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 recanalisation at 24 h were associated with CI. Main causes of clinical deterioration included symptomatic intracranial haemorrhage (sICH), persistent occlusion and cerebral oedema. 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 oedema. The outcome of CWFI was intermediate between CW and CI.


CONCLUSIONS
Early clinical profiles of evolution in thrombolysed patients vary considerably. Even with CI, it is critical to maintain vessel permeability to avoid subsequent CW.
Service of Neurology and Bone and Mineral Research Unit, Hospital Central de Asturias, Oviedo, Spain. mglezdelgado@yahoo.es
M G
MG
Delgado
P
P
Michel
M
M
Naves
P
P
Maeder
M
M
Reichhart
M
M
Wintermark
J
J
Bogousslavsky
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D011379:Prognosis; D012008:Recurrence; D012737:Sex Factors; D015996:Survival Rate; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator