Acute ischemic stroke thrombolysis- experience from a rural hospital in Kerala, India

Abstract

Outcome assessment of thrombolysis with intravenous rt-PA in acute ischemic stroke.All patients with acute ischemic stroke patients who underwent IV thrombolysis with rt-PA from January 2019 to December 2021 were studied retrospectively. Clinical efficacy outcome was the favourable outcome on modified Rankin scale at 90 days defined as a score of ≤2. During our study period, a total of 50 patients with ischemic stroke thrombolysis underwent intravenous recombinant tissue plasminogen activator (rt‑PA). The study consisted of 33 males and 17 females with a mean age of 64.82 ( 12.21 standard deviation) years. The median time from onset of symptoms to IV rt-PA administration was 120 minutes (interquartile range 90 - 160). The mean door to needle time was 50.1 ( 21.32 SD) minutes. Favourable outcome (mRS score ≤2) was observed in 38 patients (76%) at three months’ follow-up. Poor outcome (mRS score >2) was seen in the remaining 12 patients (24%).Large artery atherosclerosis had the most favourable outcome followed by small vessel occlusive stroke. Factors predicting favourable outcome in our study were age <60 years (p = 0.03), female gender (p < 0.001) and large vessel occlusion (p < 0.001). Factors predicting poor outcome were hypertension (p < 0.001), dyslipidemia (p = 0.01), prior stroke (p < 0.001) and symptomatic haemorrhage (p = 0.02). Ischemic stroke patients can be thrombolysed in a safe and effective even in rural settings if proper institutional protocol is formulated and its implementation is ensured.