Article

Intravenous thrombolysis with rt-PA is the key treatment for acute
ischemic stroke (IS), and has largely been developed at the Military Teaching
Hospital in Toulon since 2003. This report is of the results of our practices
compared with those in the literature, as well as our attempts to identify
factors predictive of a favorable outcome after thrombolysis. METHODS: All
patients treated with rt-PA for IS in the carotid territory between 2003 and 2014
were prospectively included. Disability was assessed at 3 months by modified
Rankin Scale (m-RS) scores; outcome was considered unfavorable if the m-RS score
was >2. Multivariate analyses were also performed to identify parameters
correlating with poor and favorable outcomes. RESULTS: Of the 289 patients
prospectively enrolled in the study [mean initial National Institutes of Health
Stroke Scale (NIHSS) score: 14.3], 52.5% had an m-RS score >2 at 3 months of
follow-up. Three independent predictive factors for poor functional outcomes at
the 3-month follow-up were identified: NIHSS score>12 on admission (P=0.048);
NIHSS score>8 at discharge (P<0.001); and early neurological worsening within the
first 24h (P=0.015). Early neurological improvement within 24h of rt-PA infusion
was significantly associated with recanalization of the stroke-related occluded
cerebral artery (P<0.001, r=0.37). CONCLUSION: After 12 years of practice, our
stroke unit has produced results similar to those of the major clinical studies
in terms of safety and efficacy. High NIHSS scores on admission and a lack of
neurological improvement during the first 24h of thrombolysis due to failure of
early recanalization were identified as independent predictive factors of poor
functional outcomes.
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Langue : ANGLAIS