[Thrombolytic treatment in acute ischemic stroke in a center without previous experience. Development of internal organization and first results]. / Tratamiento trombolítico del ictus isquémico agudo en un centro sin experiencia previa. Desarrollo de la organización interna y primeros resultados.

ABSTRACT

BACKGROUND AND OBJECTIVE: Treatment of acute ischemic stroke within three hours with intravenous tissue-type plasminogen activator (t-PA) has been recently approved by the European Drug Agency. We present the development of an internal organization system that has permitted thrombolytic treatment in our center without previous experience as well as the results of the first year. PATIENTS AND METHOD: Development of the thrombolysis educational program for the staff informed, of the internal organization system, and combined care protocols among the participating services. Prospective registry of patients treated with t-PA within the period 1/2004-2/2006. We collected demographic data, stroke assessment scales score (NIHSS), time to treatment, seven day and three months mortality, symptomatic hemorrhagic transformation, systemic bleedings, functional independency at three months, early significant improvement and significant deterioration. RESULTS: Fifty-three patients were treated. Mean age 65 +/- 13 years; 56% women. Mean NIHSS pre-treatment 14 +/- 4.7. Mean time to hospital arrival 62 +/- 40 minutes; door-to-treatment 68 +/- 22 minutes, and mean time from stroke onset to treatment 130 +/- 31 minutes. Symptomatic hemorrhagic transformation 5.8%. Systemic bleeding 3.8%. Seven day mortality 5.6%; three months mortality 15.1%. Early significant improvement 51%. Significant neurological deterioration 7.5%. Functional independency at three months 51%. CONCLUSIONS: Treatment of acute ischemic stroke within three hours with intravenous t-PA is safe and is associated with a favourable outcome when it is applied by neurologists specifically trained in acute stroke management.