Prerequisites, indications and contraindications of IV-lysis of ischemic stroke with rt-PA: Background and purpose

Background and purpose: To evaluate prerequisites, safety, and efficacy of iv-thrombolysis of ischemic stroke with rtPA in an academic medical center. Methods: Over a period of 2 years and 10 months all patients admitted with a diagnosis of stroke were recruited. Inclusion and exclusion criteria for iv-thrombolysis were combined from large scale randomized controlled trial s, the time window, however, could be extended up to 4 hours in subjects wi th a negative CT-scan. Prespecified outcome parameters were the modified Ra nkin Scale (mRS) and the Barthel Index (BI) at 3 months, and symptomatic he morrhagic complications. Additionally, time parameters, such as onset-admis sion-time, door-Ct-time, door-needle time, and onset-needle time were recor ded. Results: During the reported period 103 patients underwent iv-thrombol ysis, corresponding to 14.9 % of all patients with ischemic stroke, and 47 % of patients with ischemic stroke arriving in <3 hours after symptom onset . The mean baseline NIHSS was 14, the mean mRS 13 (3-34), the mean age 70 ( +/- 12) years. The following time intervalls were observed: Onset- admissio n-time 64 min., door-CT-time 27 min., admission-needle-time 80 min., and on set-needle-time 142 min. There were 4 symptomatic intracerebral hemorrhagic transformations, including 3 parenchymal hemorrhages, 2 of them lethal, an d one with almost full recovery. According to the mRS, 39% of patients had a good (mRS 0-1), 72 % a good to moderate recovery (mRS 0-2). The correspon ding figures for the BI were 60% BI 95-100 and 72% BI > 90. The mortality w as 15%. Conclusion: The iv-thrombolysis of ischemic stroke with rt-PA deman ds appropriate organisation of the pre- and in-hospital phase and can be pe rformed safely and efficaciously in daily clinical routine if inclusion and exclusion criteria as well as all safety measures during the critical phas e after therapy are strictly obeyed.