Intravenous thrombolytic therapy with rt-pa in acute stroke. Experiences from the clinical routine

Background and purpose: Only a few clinical reports about the routine use o f intravenous rt-PA for the treatment of acute ischemic stroke have been pu blished. Whether the perfusion of the extracranial parts of the internal ca rotid artery influences the outcome of the patients is still unknown, becau se the two major studies about systemic thrombolytic therapy with rt-PA in stroke (ECASS and NINDS) did not formally assess the status of the extracra nial vessels. Methods: 56 Patients were treated with intravenous rt-PA within 6 h of acut e ischemic stroke between January 1995 and May 1998. Before and within 24 h after the thrombolytic therapy usually a neurovascular diagnostic with ext ra- and transcranial Doppler-ultrasound or CT-angiography was performed. Oc clusions of the intracranial parts of the internal carotid artery (Carotid- T) were excluded from thrombolytic therapy. The outcome was assessed using the Rankin-scale at least 3 month after the therapy. Results: The average time from stroke onset to administration of treatment was 3.7 h.A parenchymal hemorrhage with clinical deterioration was found in four patients (7,1 %). Eight patients died until the followup (14,3%), fou r within 14 days. 39 patients showed a clinical improvement. Outcome and re canalization rate of the medial cerebral artery was not influenced by steno ses or occlusions of the extracranial internal carotid artery. Conclusions: Routine intravenous use of rt-PA for acute ischemic stroke sho ws safety compararable to the results of the NINDS study even in 6 h time w indow. The outcome and recanalization rate depends not on the perfusion of the extracranial parts of the internal carotid artery.