Effect of Tissue Plasminogen Activator on Treatment Outcome and Neuronal Degeneration in Acute Ischemic Stroke

Abstract

Background: Acute ischemic stroke [AIS] is a leading worldwide neurological morbidity with significant disability. Recombinant tissue plasminogen activator [r-TPA] is approved for the treatment of AIS.Neuron-specific enolase [NSE] is a marker of brain damage in patients with traumatic brain injury, stroke, and hypoxic encephalopathy. Aim of the work: The present study assessed the prognostic value of serum NSE in r-TPA treatment of patients with AIS. Patients and methods: The present prospective study included 53 patients with AIS. They comprised 25 patients who didn’t receive r-TPA and 28 patients who received r-TPA. The clinical severity of the stroke was assessed using National Institute of Health Stroke Scale [NIHSS]. A modified Rankin score was used to evaluate the degree of disability in the affected patients. Radiological imaging included echocardiography, brain computed tomography, and carotid and vertebrobasilar duplex. NSE was assessed at 24 h after r-TPA infusion. Results: Patients subjected to r-TPA treatment had significantly lower NSE one day of stroke when compared with another group [23.7 ±14.3 versus 11.9 ± 8.9; p=0.001]. Also, patients with r-TPA treatment had a significantly higher frequency of favorable outcome at day 90 [67.8 % versus 44.0 %; p=0.001]. Interestingly, NSE levels one day after stroke were significantly lower in patients with favorable outcome [14.39 ±9.6 versus 19.83 ±14.9; p=0.048] and showed significant correlation with infarct size [r=0.63;p=0.001] and NIHSS after 24h [r=0.67;p=0.001]. Conclusion: r-TPA treatment resulted in a significant decrease in NSE levels. These levels were significantly correlated with infarct size, NIHSS at 24 hours, and MRS at 90 days.