Intravenous thrombolysis with rt-PA for acute ischemic stroke within 24 h of a transient ischemic attack

摘要

Background Intravenous thrombolysis (iv-thrombolysis) with the use of rt-PA in patients after recent transient ischemic attack (TIA) is an important clinical problem. The aim of the study was to assess the impact of TIA within 24 h preceding acute ischemic stroke (AIS) on the safety and efficacy of iv-thrombolysis. Methods We retrospectively evaluated the clinical and demographic data of 400 patients with AIS who were consecutively treated with iv-thrombolysis from September 2006 to May 2011 in three stroke centers. Results At three-month follow-up, 58.0% of patients were independent (modified Rankin scale; mRS 0-2), 17.8% had died, 17.0% suffered hemorrhagic transformation (HT) and 4.3% experienced symptomatic intracerebral hemorrhage (SICH). There were 29 patients (7.3%) who had a previous ipsilateral TIA within 24 h before established stroke. In the TIA subgroup, there was no significant higher percentage of favorable outcome (p = 0.07) and higher SICH rate (p = 0.15). Multivariate analysis showed the impact of prior TIA within 24 h before stroke onset in the presence of SICH (p = 0.01), no impact of TIA on unfavorable outcomes after three months (p = 0.25) and on the mortality rate within three months (p = 0.41). Conclusion TIA within 24 h prior to ischemic stroke can portend severe intracerebral bleeding in patients qualified to iv-thrombolysis with the use of rt-PA.