Published Online
on May 8, 2003

A more recent version of this article appeared on June 1, 2003

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Submitted on November 21, 2002
Accepted on December 12, 2002

Community-Based Thrombolytic Therapy of Acute Ischemic Stroke in Helsinki

Perttu J. Lindsberg MD, PhD^*; Lauri Soinne MD; Risto O. Roine MD, PhD; Oili Salonen MD, PhD; Turgut Tatlisumak MD, PhD; Mikko Kallela MD, PhD; Olli Häppölä MD, PhD; Marjaana Tiainen MD; Elena Haapaniemi MD; Markku Kuisma MD, PhD; and Markku Kaste MD, PhD

From the Department of Neurology (P.J.L., L.S., R.O.R., T.T., O.H., M.T, M. Kaste) and Neuroscience Program, Biomedicum Helsinki (P.J.L., T.T.); Department of Radiology (O.S.); and Helsinki Emergency Medical Services (M. Kuisma), Helsinki University Central Hospital, Helsinki, Finland.

^* To whom correspondence should be addressed. E-mail: perttu.lindsberg{at}hus.fi.

Background and Purpose--Thrombolysis with alteplase is used in acute ischemic stroke within 3 hours after symptom onset in many stroke centers, but experience remains limited in Europe.

Methods--Using eligibility and management criteria similar to those published by the American Heart Association, we treated 75 consecutive patients aged 21 to 83 years (mean age, 63.6 years; median Scandinavian Stroke Scale score, 32/58) with hemispheric infarction with alteplase in 1998-2001. Their neuroradiological findings (ischemic and hemorrhagic changes) and functional outcome at 3 months were evaluated.

Results--Sixty-one percent of the patients had recovered functional independence (Barthel Index 95 to 100) at the 3-month follow-up. On the modified Rankin Scale (mRS), 37% (28/75) of patients had no or minimal symptoms (mRS 0 to 1), while 17% (13/75) remained dependent (mRS 4 to 5) and 5% (4/75) died. Cerebral parenchymal hematomas occurred in 8% (6/75) and hemorrhagic transformation in 8% (6/75) of the patients. Low initial diastolic blood pressure and administration of intravenous antihypertensive medication were associated with unfavorable outcome (mRS 3 to 6).

Conclusions--We conclude that our management protocol for thrombolytic therapy is safe. These rates of functional outcome, case fatality, and hemorrhagic cerebral events compare favorably with those of other published series of stroke thrombolysis with similar time windows and management guidelines. Associations between blood pressure and its treatment during thrombolysis with functional outcome deserve further analysis.

Key words: hemorrhage • outcome • stroke • stroke, ischemic • thrombolysis

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