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Titolo:
THROMBOLYSIS WITH INTRAVENOUS RTPA IN A SERIES OF 100 CASES OF ACUTE CAROTID TERRITORY STROKE - DETERMINATION OF ETIOLOGIC, TOPOGRAPHIC, AND RADIOLOGICAL OUTCOME FACTORS
Autore:
TROUILLAS P; NIGHOGHOSSIAN N; DEREX L; ADELEINE P; HONNORAT J; NEUSCHWANDER P; RICHE G; GETENET JC; LI W; FROMENT JC; TURJMAN F; MALICIER D; FOURNIER G; GABRY AL; LEDOUX X; BERTHEZENE Y; 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 LYON FRANCE UNIV LYON 1,BIOSTAT UNIT F-69622 VILLEURBANNE FRANCE LYON HOSPS,EMERGENCY UNIT LYON FRANCE MOUTIERS HOSP,EMERGENCY UNIT MOUTIERS FRANCE HOP NEUROL,HEMATOL & COAGULAT LAB LYON FRANCE
Titolo Testata:
Stroke
fascicolo: 12, volume: 29, anno: 1998,
pagine: 2529 - 2540
SICI:
0039-2499(1998)29:12<2529:TWIRIA>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
TISSUE-PLASMINOGEN-ACTIVATOR; MIDDLE CEREBRAL-ARTERY; FIBRINOLYTIC THERAPY; ANESTHETIZED BABOONS; ISCHEMIC STROKE; EMBOLIC STROKE; OCCLUSION; REPERFUSION; INFARCTION; AGENTS;
Keywords:
PROXIMAL INTERNAL CAROTID THROMBOSIS; HEPARIN; MANNITOL; PLASMINOGEN ACTIVATOR, TISSUE TYPE; TOMOGRAPHY, EMISSION COMPUTED; THROMBOLYTIC THERAPY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
40
Recensione:
Indirizzi per estratti:
Citazione:
P. Trouillas et al., "THROMBOLYSIS WITH INTRAVENOUS RTPA IN A SERIES OF 100 CASES OF ACUTE CAROTID TERRITORY STROKE - DETERMINATION OF ETIOLOGIC, TOPOGRAPHIC, AND RADIOLOGICAL OUTCOME FACTORS", Stroke, 29(12), 1998, pp. 2529-2540

Abstract

Background and Purpose-Although new, large, double-blind, randomized studies are needed to establish the efficiency of intravenous thrombolysis, open trials of sufficient size may also provide novel data concerning specific outcomes after thrombolysis. Methods-An open study of intravenous rtPA in 100 patients with internal carotid artery (ICA) territory strokes between 20 and 81 years of age, with a baseline Scandinavian Stroke Scale (SSS); score of <48 at entry was conducted. Inclusion time was within 7 hours after stroke onset. rtPA (0.8 mg/kg) was infused for 90 minutes, with an initial 10% bolus. Heparin was given according to 3 consecutive protocols. The SSS evaluation was done on days0, 1, 7, 30, and 90. CT scan was performed before treatment, on days 1 and 7. Etiological investigations included echocardiography and carotid Doppler sonography and/or angiography. Outcome at 1 year was documented by SSS score, the modified Rankin Scale (mRS) score, and a 10-point invalidity scale. Multivariate logistic regression was used to identify predictors of poor versus good outcome. Results-At day 90, 45 patients (45%) had a good result, defined as complete regression or slight neurological sequelae (mRS score of 0-1), 18 patients had a moderate outcome (mRS 2-3), and 31 patients had serious neurological sequelae(mRS 4-5). Six patients died, 2 with intracerebral hematoma after immediate heparin. Five of 11 patients (45.5%) treated between 6 and 7 hours had a good result. The overall intracerebral hematoma rate was 7%. Higher values of fibrin degradation products at 2 hours were observedin the subgroup with intracerebral hematomas. Significant predictors of poor outcome on multivariate logistic regression analysis were baseline SSS score of <15 (odds ratio [OR], 3.38; 95% confidence interval [CI], 1.07 to 10.74; P=0.04), indistinction between white and gray matter on CT scan (OR, 6.59; 95% CI, 2.19 to 19.79; P=0.0008), and proximal internal carotid thrombosis (OR, 3.29; 95% CI, 0.99 to 10.95; P=0.05). Conclusions-Our study confirms the safety of intravenous rtPA at adose of 0.8 mg/kg and suggests efficacy for this drug even within 7 hours. Outcome and hematoma rates were at least as favorable as for trials of therapy with a 3-hour time window. Subgroups with a poor prognosis include low baseline neurological score, baseline CT changes, and proximal ICA thrombosis. However, approximately 30% of patients with each of these characteristics show a good outcome, so their inclusion in future routine rtPA protocols is still justified.

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Documento generato il 24/09/20 alle ore 18:51:38