Téma: Original Works

Prolonged low-dose thrombolysis of infratentorial ischemic strokes our own experiences, case reports, discussion

Miroslav Brozman, Andrea Petrovičová, Daša Viszlayová, Katarína Kročková, Tibor Göbö, Agáta Frišová, Renáta Felediová, Gabriel Hajaš, Slavomíra Kováčová, Branislav Veselý

Background and Purpose: Prognosis of infratentorial ischemic strokes is very difficult to establish because of the variability of their clinical course. The posterior circulation symptoms are often gradual or stuttering with episodes of worsening and risk of sudden death. Therapeutic recanalization can be achieved by means of intravenous and intraarterial thrombolysis and can be effective even in later therapeutic window. The purpose of our study was to analyze the results of prolonged low-dose rtPA thrombolysis (LDT) in patients with subacute infratentorial strokes. Material & methods: 34 patients with subacute infratentorial strokes were treated with 20 mg IV rtPA in prolonged 48 hours infusion (0.125-0.150 mg/kg/h). NIHSS evaluation was performed 24, 48 and 72 hrs after start of therapy. Clinical result were classified as stabilized (ΔNIHSS = 0), improved (ΔNIHSS ≤ 1) or worsened (ΔNIHSS ≥ 1) at the end of NDT. We analyzed hemorrhagic changes on CT or MRI and standard hemocoagulation parameters. Modified Rankin scale was evaluated 3 months after stroke. Results: Therapeutic interval for LDT was 4.5-144 hours (mean 38.7 hours). Initial NIHSS was in the range between 1–31 (mean NIHSS =8, median NIHSS =6). Worsening of NIHSS before start of LDT was in the range 4-17 NIHSS, mean ΔNIHSS = 6. During LDT therapy have been 20 of 34 patients (58.8 %) stabilized and their worsening stopped; 13 patients (38.2 %) improved; 1 patient worsened (2.9 %). Results of mRS 3 months after discharge: mRS 0 = 3 pts (8.8 %), mRS 1 = 10 pts (29.4 %), mRS 2 = 4 pts (11.8 %), mRS 3 = 6 pts (17.6 %), mRS 4 = 6 pts (17.6 %), mRS 5 = 1 pt (2.9 %), mRS 6 = 4 pts (11.8 %). Half of all patients achieved independence after 3 months (mRS = 0-2). We did not observe any hemorrhagic intracranial transformation neither local or systemic hemorrhage. We did not detect any significant changes of hemocoagulation parameters. Conclusions: Prolonged low-dose intravenous rtPA thrombolysis seems to be effective and safe alternative therapy of subacute infratentorial ischemic strokes with gradual or stuttering course of posterior circulation symptoms.

Ročník 2009  Témy časopisu Neurology 3 / 2009

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