title: Feasibility and efficacy of thrombolysis in acute ischemic stroke: A study from National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.
abstract: BACKGROUND
  Stroke is the major cause of morbidity and mortality worldwide. The number of stroke patients receiving recombinant tissue plasminogen activator (rt-PA), also known as Alteplase, in the developing world is extremely low. We aim to study the feasibility and efficacy of thrombolysis for the 1(st) time in our country.
  
  
  METHODS
  In this retrospective study (July 2012-August 2015), acute ischemic stroke patients who were thrombolyzed within 3 h of stroke onset were included. Their demographic profiles, clinical profiles, risk factors, type of thrombolytic used, and outcomes were systematically recorded and analyzed.
  
  
  RESULTS
  A total of 9 patients were thrombolyzed. The mean time from the onset of stroke symptoms to first dose of rt-PA (onset to treatment) was 1.2 h. Six patients had good neurological outcome as measured by modified Rankin Scale (mRS). The median mRS at discharge was 3. Thrombolysis-related post treatment complication was noted in 44.4%, of which nonfatal intracranial bleed occurred only in 2 patients (22.2%). None of the patients receiving intravenous tenecteplase had thrombolysis-related complications, and none of the patients had fatal intracranial bleed.
  
  
  CONCLUSIONS
  This study clearly demonstrates the beginning of a feasible and effective thrombolysis in the treatment of acute ischemic stroke in Nepal.
authors.affiliation: Department of Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.
authors.forename: Lekhjung
authors.initials: L
authors.lastname: Thapa
authors.affiliation: Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.
authors.forename: Shikher
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.
authors.forename: Pratyush
authors.initials: P
authors.lastname: Shrestha
authors.affiliation: Department of Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.
authors.forename: Suman
authors.initials: S
authors.lastname: Bhattarai
authors.affiliation: Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.
authors.forename: D N
authors.initials: DN
authors.lastname: Gongal
authors.affiliation: Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.
authors.forename: U P
authors.initials: UP
authors.lastname: Devkota
keywords: Ischemic stroke; Nepal; thrombolysis; tissue plasminogen activator