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Titolo:
OPEN TRIAL OF INTRAVENOUS TISSUE-PLASMINOGEN ACTIVATOR IN ACUTE CAROTID TERRITORY STROKE - CORRELATIONS OF OUTCOME WITH CLINICAL AND RADIOLOGICAL DATA
Autore:
TROUILLAS P; NIGHOGHOSSIAN N; GETENET JC; RICHE G; NEUSCHWANDER P; FROMENT JC; TURJMAN F; JIN JX; MALICIER D; FOURNIER G; GABRY AL; LEDOUX X; DEREX L; BERTHEZENE Y; ADELEINE P; XIE J; FFRENCH P; DECHAVANNE M;
Indirizzi:
HOP NEUROL,CEREBROVASC UNIT,59 BLVD PINEL F-69003 LYON FRANCE HOP NEUROL,ATAXIA RES CTR F-69003 LYON FRANCE HOP NEUROL,DEPT NEURORADIOL F-69003 LYON FRANCE CTR HOSP LYON SUD,EMERGENCY UNIT LYON FRANCE UNIV LYON 1,BIOSTAT UNIT F-69365 LYON FRANCE MOUTIERS HOSP,EMERGENCY UNIT MOUTIERS FRANCE HOSPICES CIVILS LYON,HEMATOL & COAGULAT LAB LYON FRANCE
Titolo Testata:
Stroke
fascicolo: 5, volume: 27, anno: 1996,
pagine: 882 - 890
SICI:
0039-2499(1996)27:5<882:OTOITA>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
MIDDLE CEREBRAL-ARTERY; ACUTE ISCHEMIC STROKE; THROMBOLYTIC THERAPY; URGENT THERAPY; OCCLUSION; MINUTES;
Keywords:
HEPARIN; MANNITOL; PLASMINOGEN ACTIVATOR, TISSUE TYPE; THROMBOLYTIC THERAPY; TOMOGRAPHY, EMISSION COMPUTED;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
43
Recensione:
Indirizzi per estratti:
Citazione:
P. Trouillas et al., "OPEN TRIAL OF INTRAVENOUS TISSUE-PLASMINOGEN ACTIVATOR IN ACUTE CAROTID TERRITORY STROKE - CORRELATIONS OF OUTCOME WITH CLINICAL AND RADIOLOGICAL DATA", Stroke, 27(5), 1996, pp. 882-890

Abstract

Background and Purpose Pilot studies using early thrombolytic therapyin stroke have suggested that recombinant tissue plasminogen activator (rTPA) might be effective. While large, double-blind, randomized studies are needed, open trials could generate hypotheses concerning (1) the clinical correlations of outcome, (2) the significance of CT scan data during the first week, and (3) the use of adjunctive therapies. Methods We performed an open trial of intravenous rTPA on patients referred to our emergency service with all types of ischemic stroke in thecarotid territory. All patients between 20 and 81 years hospitalized during 1994 with completed stroke in the internal carotid artery territory and a baseline Scandinavian Stroke Scale score lower than 48, even with severe disturbances of consciousness, were included. The inclusion time was within 7 hours after stroke onset. A 0.8-mg/kg dose of rTPA was infused fur 90 minutes. Intravenous heparin was given either immediately at efficient dosage or after 24 hours. Mannitol was used in patients with severe presentation. The Scandinavian Stroke Scale evaluation was done at baseline, 3 hours, and 1, 7, 30, and 90 days. The CTscan was performed before the treatment and at days 1 (24 +/- 6 hours) and 7. Results Forty-three consecutive patients met the criteria of the protocol. The mean age at inclusion was 65 +/- 10.4 years, and themean interval to treatment was 232 +/- 79 minutes. At day 90, 25 patients (58.1%) exhibited a complete regression of symptoms, and 3 had moderate neurological sequelae. Thirteen patients had severe neurological sequelae, 11 with infarcts and 2 with secondary parenchymal hematomas. Two patients died (4.6%), 1 with hematoma. The overall hematoma rate was 6.9%. Excellent outcome at day 90 was significantly correlated with major neurological improvement at day 1. Intravenous immediate heparin versus delayed heparin after 24 hours improved the ischemic outcome but not the overall outcome. Reinfarction syndromes after major neurological improvement, likely to be rethrombosis syndromes, were observed in 3 patients (6.9%). For the day 1 CT scan. poor outcome was associated with the presence of structured and homogeneous hypodensities likely to represent classic infarcts, as confirmed by day 7 CT scan. Conversely, total recovery was significantly associated with the absenceof any image or with unstructured hypodensities, a particular type ofimage characterized by its heterogeneous darkness and often polylobarshape. This type of image disappeared at day 7 in 17.6% of the cases and is likely to represent reperfusion images and/or incomplete ischemic damage. Conclusions The results obtained in this open, small study suggest safety and effectiveness of rTPA thrombolysis at the dose of 0.8 mg/kg within 7 hours in acute strokes of the carotid territory, including highly serious baseline neurological presentations, until age 81 years and under special therapeutic conditions. Complete recovery issignificantly associated with major neurological improvement during the first 24 hours and the presence of a particular type of image at day 1 CT scan characterized by an unstructured hypodensity, often polylobar and heterogeneous, which is likely to correspond to reperfusion images.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 24/09/20 alle ore 21:15:06