One-year follow-up in acute stroke patients treated with rtPA in clinical routine

Background and Purpose-A recent placebo-controlled study provided evidence of a sustained benefit at 1 year from systemic thrombolysis in patients wit h acute ischemic stroke. The scope of the present study is to determine whe ther comparable results may be attained in everyday practice if current man agement guidelines are closely met. Methods-Between March 1996 and July 1998, 150 consecutive patients with acu te ischemic stroke were treated with systemic thrombolysis using alteplase, strictly in accordance with American Heart Association (AHA) guidelines. T he patients were followed up for 12 months after treatment. Results-Baseline characteristics and complication rates were comparable to those of the National Institute of Neurological Disorders and Stroke (NINDS ) study, except for a somewhat younger age (mean 63 years) and lower Nation al Institutes of Health Stroke Scale score (median 11). At 1 year, 41% of o ur patients showed minimal or no disability (Rankin scale score of 0 or 1), comparable to 41% in the NINDS rtPA group. The overall rate of recurrent s troke was 6.6% and the transient ischemic attack rate 3.3% at 1 year. Six p atients (4%) died after the first 3 months, none of them due to recurrent s troke, and 5 had already been severely disabled at 3 months. Conclusions-These observations further encourage the routine use of rtPA fo r the treatment of acute ischemic stroke in strict accordance with the AHA guidelines.