J Korean Neurol Assoc.  2001 Jul;19(4):364-369.

Intravenous r-tPA Therapy in Acute Ischemic Stroke: The Implication of Immediate Neurological Improvement for the Long-term Outcome

• Bae JS
• Yu KH
• Kim DH
• Whang SH
• Kim HC
• Kim SM
• Ma HI
• Jung SC
• Lee BC

Abstract

BACKGROUND: Intravenous recombinant tissue plasminogen activator (r-tPA) infusion is the only established treatment for acute ischemic stroke so far. We explored whether the demonstrated efficacy of r-tPA could be applied to communi-ty-based hospitals in Korea and whether the immediate improvements after r-tPA infusion had any predicting value for long-term outcomes.
METHODS
Twenty-six patients (mean age, 69; 46% female) with acute ischemic stroke were treated with r-tPA, abiding by the National Institute of Neurological Disorders and Stroke (NINDS) protocol. The Neurological status was measured with the National Institutes of Health Stroke Scale (NIHSS) at baseline, at 1 hour after r-tPA , at 24 hours, and at 7 days and the functional outcome was evaluated with the modified Rankin scale (mRS) and Barthel Index at 90 days after stroke.
RESULTS
Of 26 patients, 16 (62%) made full recovery or became independent, 4 (15%) had severe physical disability, and 6 (23%) patients died. Three patients (11.5%) had intracranial hemorrhage (asymptomatic, 2; symptomatic, 1). There were no significant differences in age, sex, risk factors, baseline NIHSS scores, hemorrhagic complication, initial brain CT abnormalities, and onset to needle time between good (full recovery or mRS 0-2) and poor groups (mRS 3-5 or death) at day 90, except for the improvement of NIHSS examined at 1 hour after r-tPA (repeated measured ANOVA test, p<0.01).
CONCLUSIONS
The NINDS r-tPA protocol is feasible in the community-based hospitals in Korea with the safety and efficacy comparable to the results of NINDS r-tPA trials. In addition, we suggest that the immediate neurological improvement after r-tPA be a predictor for favorable long-term outcomes. (J Korean Neurol Assoc 19(4):364~369, 2001)

Keyword

Tissue plasminogen activator; Thrombolytic therapy; Treatment outcome; Cerebral infarction

MeSH Terms

Brain
Cerebral Infarction
Humans
Intracranial Hemorrhages
Korea
National Institute of Neurological Disorders and Stroke
National Institutes of Health (U.S.)
Needles
Risk Factors
Stroke*
Thrombolytic Therapy
Tissue Plasminogen Activator
Treatment Outcome
Tissue Plasminogen Activator