EARLY INTRAVENOUS THROMBOLYSIS FOR ACUTE ISCHEMIC STROKE IN A COMMUNITY-BASED APPROACH

Background and Purpose-Controlled multicenter studies have demonstrate d the efficacy of systemic recombinant tissue-type plasminogen activat or (rtPA) treatment in selected cases of acute ischemic stroke. The fe asibility of this therapeutic option in clinical practice was assessed in a community-based approach. Methods-We offered rtPA treatment to s troke patients in a prospective open-label monocenter study applying i nclusion criteria similar to those of the National Institute of Neurol ogical Disorders, and Stroke study. In order to treat patients within 3 hours of symptom onset, a referral system was used by which eligible patients from all over the city of Cologne, Federal Republic of Germa ny, were rushed to the Department of Neurology of the University Hospi tal. We present data on the effectiveness of the referral system and t he outcome results of the first 100 consecutive patients treated withi n an Is-month period. Results-Of 453 consecutive patients with a presu med diagnosis of acute stroke referred to our department between March 1996 and August 1997, 100 patients (22%) were treated with intravenou s thrombolysis, 26% of them within 90 minutes of symptom onset. The av erage time from stroke onset to arrival at our department was 78 minut es, and from arrival to treatment 48 minutes. After 3 months, 53 patie nts recovered to fully independent function. The rates of total, sympt omatic, and fatal intracerebral hemorrhage were 11%, 5%, and 1%, respe ctively. Overall mortality was 12%. Conclusions-Thrombolysis with rtPA was effectively applied in routine management of stroke patients in a community-based approach with acceptable efforts and without addition al costs. Under these circumstances, outcome and complication rates we re comparable to those of multicenter trials.