급성기 허혈성 뇌졸중에서 정맥내 t-PA 혈전용해치료법의 안전성 및 효과 : 지역기반 일개 대학병원 연구

Abstract

Department of Neurology, Inje University, Ilsan Paik Hospital B a c k g ro u n d: Clinical trials demonstrated that intravenous tissue plasminogen activator (t-PA) was safe and effective in hyperacute ischemic stroke. Our objective was to determine whether t-PA therapy could be used safely and effectively in a community-based university hospital. Methods: From April 2000 to July 2004, retrospective and prospective data of intravenous t-PA therapy were collected in Ilsan Paik Hospital. Efficacy was assessed by the improvement of National Institutes of Health Stroke Scale (NIHSS) by 4 or more points, the marked improvement (NIHSS decreased ≥10 points or a decrease to an NIHSS score of ≤3), and modified Rankin scale (mRS) at discharge. Safety was assessed by symptomatic intracranial hemorrhage and mortality. R e s u l t: Sixty-eight patients were treated with intravenous t-PA (mean age; 67±13, median NIHSS; 18). Only three (4%) patients were small-vessel occlusion. Time interval from onset to treatment was 151±40 minutes. Improvement of NIHSS by 4 or more points at discharge occurred in thirty-three patients (48%). Twenty-three patients (34%) showed marked improvement. According to mRS, 13% (9/68) of patients had no or minimal symptoms (mRS 0-1) and 19% (13/68) had mild to moderate disability (mRS 2-3), while 50% (34/68) remained dependent and 17% (12/68) died. Five patients (7.3%) had symptomatic intracranial hemorrhage. Three deaths were attributed to symptomatic intracranial hemorrhage. Conclusions: Intravenous t-PA therapy was safe in the setting of a community-based university hospital in spite of inferior efficacy compared to those of previous clinical trials. However, considerable number of patients showed marked improvement with t-PA therapy.