title: Intravenous thrombolysis for acute ischemic stroke patients presenting with mild symptoms.
abstract: BACKGROUND
  Thrombolysis of ischemic stroke patients presenting with mild symptoms is controversial.
  
  
  OBJECTIVE
  We aimed to describe the clinical outcome and frequency of infarcts and symptomatic intracerebral hemorrhages on follow-up imaging of such thrombolysis-treated patients.
  
  
  METHODS
  Our cohort included 1398 consecutive ischemic stroke patients treated with intravenous thrombolysis at the Helsinki University Central Hospital, years 1995-2010. We analyzed the patients according to baseline National Institutes of Health Stroke Scale: ≤2, 3-4, 5-6, and >6. In our institution, visualization of an artery occlusion or perfusion deficit is required for thrombolysis with National Institutes of Health Stroke Scale ≤ 2. We used univariate and multivariable methods to describe the cohort and study associations between the variables. Excellent three-month outcome was defined as modified Rankin Scale 0-1.
  
  
  RESULTS
  Fifty-eight (4·1%) patients were treated with National Institutes of Health Stroke Scale ≤ 2, another 194 (13·6%) with 3-4 points, and 236 (16·5%) with 5-6 points. With National Institutes of Health Stroke Scale ≤ 2, 45 (78%) of the patients had excellent three-month outcome, achieved in 116 (59%) patients with National Institutes of Health Stroke Scale 3-4, in 130 (55%) with National Institutes of Health Stroke Scale 5-6, and in 241 (26%) with National Institutes of Health Stroke Scale > 6. Frequencies of symptomatic intracerebral hemorrhage (European Cooperative Acute Stroke Study-2) were 0%, 2·6%, 2·1%, and 8·1%, and visible infarcts on follow-up imaging 48%, 43%, 48%, and 74%, respectively. In patients with baseline National Institutes of Health Stroke Scale ≤ 6, poor outcome was associated with previous stroke, diabetes, elevated admission blood glucose, and development of intracerebral hemorrhage.
  
  
  CONCLUSIONS
  Half of patients presenting with National Institutes of Health Stroke Scale 0-6 developed an infarction despite thrombolysis, and 40% had poor outcome, which was associated with glucose metabolism and hemorrhagic complications. Managing thrombolysis candidates with mild symptoms warrants individual consideration often supported by multimodal imaging.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki, Finland. daniel.strbian@hus.fi
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.forename: Katja
authors.initials: K
authors.lastname: Piironen
authors.forename: Atte
authors.initials: A
authors.lastname: Meretoja
authors.forename: Tiina
authors.initials: T
authors.lastname: Sairanen
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.forename: Marjaana
authors.initials: M
authors.lastname: Tiainen
authors.forename: Ville
authors.initials: V
authors.lastname: Artto
authors.forename: Kirsi
authors.initials: K
authors.lastname: Rantanen
authors.forename: Olli
authors.initials: O
authors.lastname: Häppölä
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Perttu J
authors.initials: PJ
authors.lastname: Lindsberg
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000188:drug therapy / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator