Prognostic factors of thrombolytic therapy in hyperacute ischemic stroke

초록

Background Thrombolytic therapy is the only approved treatment of hyperacute stroke, but studies about the prognostic factors are scanty. We tried to find which factors influence the outcome of thrombolytic therapy in hyperacute stroke. Methods During the period of recent two and a half year, 61 ischemic stroke patients were treated by recombinant tissue plasminogen activator (rTPA) within 3 hours after onset, strictly according to the NINDS rTPA protocol. Clinical monitoring was done by NIH Stroke Scale (NIHSS) daily for 1 week, by modified Rankin scale(mRS) at baseline and three months, by transcranial Doppler (TCD) at baseline, 1, 3, and 24 hours after the thrombolytic therapy. Various factors such as stroke subtype, past medical history, laboratory result and brain imaging were analyzed for the possible relationship with the early (1 day) and late (1 week) improvement of more than 3 point by NIHSS and 3 months mRS after thrombolytic therapy. Result Old age, prior stroke history, atrial fibrillation and serum lipoprotein(a) level, cardioembolic subtype were significantly associated with no early improvement (p<0.05). On the other hand, late improvement was negatively associated with relatively large estimated infarct size on initial CT and symptomatic intracranial hemorrhage on following imaging (p<0.05). Three months prognosis was associated with hyperdense MCA sign and symptomatic intracranial hemorrhage on brain imaging. Thrombolysis in brain ischemia (TIBI) grade by TCD monitoring was negative correlated with NIHSS for 1 weak (p<0.05). Conclusion These results suggest that initial CT finding is an important prognostic factor of acute outcome. Lipoprotein (a) level might be associated with the thrombolytic therapy. TCD can be used as a useful indicator of successful reperfusion.