From the Klinik für Neurologie der Universität zu Köln
(M.G., C.S., S. Schmülling, J.R., M.N., S. Schneweis, W.-D.H.), Germany,
and the Institut für Nofallmedizin der Berufsfeuerwehr Köln (A.L.).
Correspondence to Prof Dr W.-D. Heiss, Klinik für Neurologie der Universität zu Köln, Joseph-Stelzmann-Str 9, D-50924 Köln, Germany.
Background and Purpose—Controlled
multicenter studies have demonstrated the efficacy of systemic
recombinant tissue-type plasminogen activator
(rtPA) treatment in selected cases of acute ischemic
stroke. The feasibility of this therapeutic option in clinical practice
was assessed in a community-based approach.
Methods—We offered rtPA treatment to stroke patients in a
prospective open-label monocenter study applying inclusion criteria
similar to those of the National Institute of Neurological Disorders,
and Stroke study. In order to treat patients within 3 hours of symptom
onset, a referral system was used by which eligible patients from all
over the city of Cologne, Federal Republic of Germany, were rushed to
the Department of Neurology of the University Hospital. We present
data on the effectiveness of the referral system and the outcome
results of the first 100 consecutive patients treated within an
18-month period.
Results—Of 453 consecutive patients with a presumed diagnosis of
acute stroke referred to our department between March 1996 and August
1997, 100 patients (22%) were treated with intravenous
thrombolysis, 26% of them within 90 minutes of symptom
onset. The average time from stroke onset to arrival at our department
was 78 minutes, and from arrival to treatment 48 minutes. After 3
months, 53 patients recovered to fully independent function. The rates
of total, symptomatic, and fatal
intracerebral hemorrhage were 11%, 5%, and
1%, respectively. Overall mortality was 12%.
Conclusions—Thrombolysis with rtPA was effectively
applied in routine management of stroke patients in a community-based
approach with acceptable efforts and without additional costs. Under
these circumstances, outcome and complication rates were comparable to
those of multicenter trials.
© 1998 American Heart Association, Inc.
Original Contributions
Early Intravenous Thrombolysis for Acute Ischemic Stroke in a Community-Based Approach
Key Words: stroke management • stroke, acute • thrombolytic therapy
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