Evaluation for Prognosis and Complication at Violation of Treatment with rtTA in Acute Ischemic Stroke

Kim,  Sin Chul; Chen,  Yil Young; Kim,  Myung Chun; Ko,  Young Gwan

J Korean Soc Emerg Med > Volume 13(3); 2002 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2002;13(3): 289-293.

Evaluation for Prognosis and Complication at Violation of Treatment with rtTA in Acute Ischemic Stroke

Sin Chul Kim, Yil Young Chen, Myung Chun Kim, Young Gwan Ko

Department of Emergency Medicine, College of Medicine, Kyung Hee University, Seoul, Korea. edkmc@chollian.net

ABSTRACT

PURPOSE:
In many other countries, based on research, recombinant tissue plasminogen activator (r-tPA) has been approved for the treatment of acute ischemic strokes. However, in Korea, little research has been done till now, in spite of using r-tPA widely. We sought to assess the feasibility and the efficacy of treatment and to evaluate the prognosis and complications at the violation of using r-tPA. Our study was compared with other previous studies.
METHODS:
A retrospective review is presented of 25 the cases of patients with acute ischemic stroke treated with rtPA according to the National Institutes of Neurological Disorders and Strokes (NINDS) protocol. We classified the groups by protocol violation (time, blood pressure, and computed tomography). We then analyzed neurologic outcomes by using the National Institutes of Health Strokes Scale (NIHSS) and complications based on whether or not intracerebral hemorrhage (ICH) had occurred.
RESULTS:
Of the 25 patients (mean age: 57 males: 19), 6 had time violation (onset time > 180 min), 4 had blood-pressure violation (systolic BP > 185 mmHg), 5 had CT violation (low density at initial CT). The NIHSS score improved in 64% of all patients after 24 hours. However, improvement was lower in the case of deviation present than it was in the case of deviation absent (time, blood pressure, and CT, respectively, 20%, 50%, and 40%; p-value respectively 0.0274, 0.8350, and 0.4125). ICH occurred in 6 cases, but in cases of deviation present, ICH occurred at a greater frequency.
CONCLUSION:
Our safety and feasibility of outcome compared favorably with NINDS and other previous studies. In addition, we confirmed that the presence of protocol deviation was associated a poor outcome.

Key words: Ischemic stroke, Thrombolytic therapy, r-tPA, Protocol violation