The effect of intravenous thrombolytic and intraarterial interventional procedures on acute stroke: First-year clinical experience of a stroke center in eastern anatolia

The effect of intravenous thrombolytic and intraarterial interventional procedures on acute stroke: First-year clinical experience of a stroke center in eastern anatolia

Treating acute stroke in the early period can lead to reperfusion and minimize the loss of neurological function. In this study, our aim is to analyze the prognosis of our patients who underwent intravenous thrombolytic and/or mechanical interventional treatment in the last one year in our newly opened stroke center and evaluate our clinical experience. A total of 166 patients with a mean age of 68.7±11.3 who underwent intravenous r-tPA ± mechanical thrombectomy in our stroke center were included in the study. The mean time from symptom-to-door was 138.6±48.3 min, and the mean NIHSS score on admission was 10.9±4.1. Intravenous r-tPA was preferred for treatment in 59.6% (99) patients. The mortality rate was 25.3% (42) for all patients. The mortality rate was 15.1% (15/99) for patients receiving intravenous r-tPA, and based on this finding, the mortality risk was found to be significantly higher in patients who did not receive intravenous r-tPA (p < 0.001). The mortality rate was 40% (6/15) for patients undergoing only mechanical thrombectomy (p: 0.145). The mRS score of the patients who received intravenous r-tPA was 3.18 in the first month, whereas the score of the patients who did not receive intravenous r-tPA was 3.74 (p:0.010). As a result, mortality and sequelae rates have been significantly reduced with the use of thrombolytic therapy and interventional neurovascular procedures. Although our center is newly opened, it shows promise for the upcoming years.

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  • 1. Aydin Ozturk P, Ozturk U, Ozturk O. Relationship between arylesterase activity and pulse pressure index in patients with an acute ischemic stroke. J Exp Clin Med. 2021;38:246-50.
  • 2. Saver JL. Time is brain—quantified. Stroke. 2006;37:263-6.
  • 3. Fisher M. Characterizing the target of acute stroke therapy. Stroke. 1997;28:866-72.
  • 4. Group I-C. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012;379:2352-63.
  • 5. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384:1929-35.
  • 6. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. stroke. 2018;49:e46-e99.
  • 7. Lewandowski C, Barsan W. Treatment of acute ischemic stroke. Ann Emerg Med. 2001;37:202-16.
  • 8. Van Swieten J, Koudstaal P, Visser M, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604-7.
  • 9. Topçuoğlu MA, Arsava EM, Özdemir AÖ, Uzuner N. Stroke unıt: general principles and standards. Turk J Cerebrovasc Dis 2015;21:4-22.
  • 10. Gargano JW, Wehner S, Reeves MJ. Presenting symptoms and onset-toarrival time in patients with acute stroke and transient ischemic attack. Journal of stroke and cerebrovascular diseases. 2011;20:494-502.
  • 11. Kıyan S, Özsaraç M, Ersel M, et al. Retrospective analysis of 124 acute ischemic stroke patients who attended to the emergency department in one year period. J Acad Emerg Med. 2009;8:15-20.
  • 12. Soyudoğru S, AKDENİZ YS, İpekci A, et al. Evaluation of Ischemic Stroke and Transient Ischemic Attack Patients Admitted to the Emergency Department. Phnx Med J. 2:16-24.
  • 13. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. New England J Med. 2008;359:1317-29.
  • 14. Lees KR, Bluhmki E, Von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375:1695- 703.
  • 15. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. Engl J Med. 2015;372:11- 20.
  • 16. Khatri P, Abruzzo T, Yeatts S, et al. Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology. 2009;73:1066-72.
  • 17. Broderick JP, Palesch YY, Demchuk AM, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013;368:893- 903.
  • 18. Mulder MJ, Jansen IG, Goldhoorn R-JB, et al. Time to endovascular treatment and outcome in acute ischemic stroke: MR CLEAN registry results. Circulation. 2018;138:232-40.
  • 19. Ciccone A, Valvassori L, Nichelatti M, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med. 2013;368:904-13.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: 4
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )
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