Hesna BEKTAŞ, Gönül VURAL, Şadiye GÜMÜŞYAYLA, Orhan DENİZ

AKUT İSKEMİK İNMEDE İNTRAVENÖZ TROMBOLİTİK TEDAVİ: ANKARA ATATÜRK EĞİTİM VE ARAŞTIRMA HASTANESİ NÖROLOJİ KLİNİĞİ DENEYİMİ

AMAÇ: Akut iskemik inmede intravenöz doku plazminojen aktivatörü iv t-PA semptomlar başladıktan sonraki ilk 3-4.5 saatte uygulanan tek tedavi yöntemidir. Çalışmamızın amacı kliniğimizin iv t-PA deneyimini paylaşmaktır.GEREÇ VE YÖNTEMLER: Temmuz 2014- Haziran 2015 tarihleri arasında kliniğimizde iv t-PA uygulanan 14 hastanın prospektif olarak biriktirilen verileri değerlendirildi.BULGULAR: Çalışmaya yaş ortalaması 62.2 ± 15.3 olan 13’ü erkek % 93 1’i kadın % 7 toplam 14 hasta alındı. Hastaların semptom- kapı zamanı ortalaması 68.07±34.417 dk , kapı- nöroloji konsultasyonu zamanı ortancası 22.50 dk Çeyreklikler Arası Genişlik – ÇAG: 20 , kapı- beyin tomografi zamanı ortancası 16.50 dk ÇAG:12 ve kapı- ilaç zamanı ortalaması 87.57± 26.129 dk idi. NIHSS ortalaması infüzyon öncesi 14.57 ± 5.983 , infüzyon sonrası 10.71 ± 6.354 , 1. ayda ortanca 2 ÇAG: 6 , 3.ayda 2 ÇAG: 4 idi. 1 hastada ilk 12 saat içinde nörolojik kötüleşme oldu. Beyin bilgisayarlı tomografisinde BT ciddi hematom saptandı, takiplerde hasta ex oldu. 2 hastada 24 saat sonra çekilen BT’de hemorajik transformasyon gözlendi. Modifiye Rankin Skala ortancası 1.ayda 2 ÇAG:2 , 3.ayda 0 ÇAG: 3 idi. Barthel indeksi ortancası 1.ayda 85 ÇAG:23 3.ayda 100 ÇAG:13 idi.SONUÇ: Akut iskemik inmede iv t-PA ilk 3 ayda fonksiyon kaybını azaltmaktadır

Anahtar Kelimeler:

inme, iv t-PA, trombolitik tedavi

INTRAVENOUS THROMBOLYTİC THERAPHY IN ACUTE ISCHEMİC STROKE: THE EXPERİENCE OF THE NEUROLOGY DEPARTMENT OF ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL

OBJECTIVE: Intravenous tissue plasminogen activator rt-PA is the only treatment of acute ischemic stroke when given within 3-4.5 hours of symptom onset. The main aim of this study was to review our experience of iv t-PA treatment.MATERIAL AND METHODS: The data of the 14 patients who were treated with iv t-PA in our clinic between July 2014June 2015 were evaluated prospectively.RESULTS: Fourteen patients 13 male 93% , 1 female 7% were included to the study. The mean age was 62.2 ± 15.3 .The mean time of the symptoms to door was 68.07 ± 34.417 min . The median time of the door to neurology consultation was 22.50 min Interquartile range – IQR: 20 , the door to brain computarized tomography CT was 16.50 min IQR:12 . The mean time of the door to drug infusion was 87.57± 26.129 min . The median of NIHSS before infusion and after infusion was respectively 14.57 ± 5.983 and 10.71 ± 6.354 . The mean of NIHSS at 1. Month and 3. Month was respectively 2 IQR: 6 and 2 IQR: 4 . One patient had neurological deterioration within the first 12 hours. Intracranial hemorrage was detected on CT and he died after 10 days. Hemorrhagic transformation on CT scan was observed in 2 patients after 24 hours. The median of Modified Rankin Scale at 1.month and 3. Month was respectively 2 IQR:2 and 0 IQR: 3 . The median of Barthel index at 1. Month and 3. Month was respectively 85 IQR:23 and 100 IQR:13 .CONCLUSION: Our analysis suggested that the administration of iv t-PA in acute ischemic stroke was associated with better functional outcome in the first 3-month period

Keywords:

stroke, iv t-PA, thrombolytic treatment,

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