• Perttu J Lindsberg, Lauri Soinne, Risto O Roine, Oili Salonen, Turgut Tatlisumak, Mikko Kallela, Olli Häppölä, Marjaana Tiainen, Elena Haapaniemi, Markku Kuisma, and Markku Kaste.
• Department of Neurology, Biomedicum Helsinki, Helsinki University Central Hospital, PO Box 700, Helsinki, FIN-00029 HUS, Finland. perttu.lindsberg@hus.fi
• Stroke. 2003 Jun 1;34(6):1443-9.

Background And PurposeThrombolysis with alteplase is used in acute ischemic stroke within 3 hours after symptom onset in many stroke centers, but experience remains limited in Europe.MethodsUsing 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.ResultsSixty-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).ConclusionsWe 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.

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