Intravenous tissue plasminogen activator thrombolysis in patients without major arterial occlusion seems to be safe and effective.
BACKGROUND
It is not clear whether tissue plasminogen activator (t-PA) thrombolysis in patients without major arterial occlusion is effective or safe.


METHODS
Consecutive anterior circulation stroke patients treated with t-PA within 3 h of onset were studied. The patients were divided into three groups according to magnetic resonance angiography findings before t-PA infusion: ICA group, ICA occlusion; MCA group, M1 and M2 occlusion, and no occlusion group. Clinical characteristics, the presence of hemorrhagic transformation on T₂* at 24 h after t-PA thrombolysis, and outcome at 3 months were compared among the three groups.


RESULTS
112 patients were enrolled. The no occlusion group had 21 (18.8%) patients, the ICA group had 29 (25.9%), and the MCA group had 62 (55.4%). The frequency of hemorrhagic transformation was only 4.8% in the no occlusion group (31.0% for the ICA group, and 48.4% for the MCA group, p = 0.0012). At 3 months after t-PA therapy, 61.5% of the no occlusion group had a favorable outcome (modified Rankin score 0-1), which was the highest among the three groups (15.0% for the ICA group, and 41.5% for the MCA group, p = 0.0203).


CONCLUSIONS
Intravenous t-PA therapy in acute stroke patients without major artery occlusion seems to be safe and effective.
Kimura
Kazumi
K
Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan. kimurak@med.kawasaki-m.ac.jp
Iguchi
Yasuyuki
Y
Shibazaki
Kensaku
K
Sakamoto
Yuki
Y
Watanabe
Masao
M
D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000139:chemically induced / Q000188:drug therapy; D001794:Blood Pressure / Q000187:drug effects; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000139:chemically induced; D007276:Injections, Intraventricular / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator