Efficacy of Thrombolytic Therapy in Treatment of Patients with Ischemic Stroke

Abstract

The purpose: to evaluate the effectiveness of thrombolytic therapy in patients with ischemic stroke according to radiological methods.Materials and methods. The study included 60 people who were divided into two groups. The main group included 34 (56.7%) patients with ischemic stroke (20 men and 14 women) aged 22 to 78 years (mean age 62 ± 8.6 years) who were treated in Republican research center of emergency medical care. The control group consisted of 26 (43.3%) patients to estimate the parameters of normeperidine in the middle cerebral artery (MCA): the maximum blood flow velocity, linear blood flow velocity, index Gosling (PI) and coefficient overshoot (KO). Evaluation of patients included: assessment of nevrostatus according NIHSS scale, computered tomograhy of brain to exclude hemorrhagic stroke, transcranial and extracranial arteries Duplex scanning, digital subtraction angiography. Thrombolysis was performed to all patients of main group with ischemic stroke: systemic thrombolysis with streptokinase – in 17 (50%) cases, selective thrombolysis of Actilyse – 17 (50%). Thrombolysis was performed in a period from 90 minutes to 4 hours after the manifestation of symptoms. Results. Significant positive changes were observed in 22 (64.7%) patients. Asymptomatic hemorrhagic transformation of ischemic lesion was observed in 4 (11.7%). In acute occlusion of the internal carotid artery recanalization was registered only in 11.7% of cases, while the M1 MCA occlusion segment – at 52.9%. Transcranial Doppler is manifested by registration of hyperperfusion flow after thrombolysis in the presence of residual flow to thrombolysis. Re-occlusion was observed in 2 (5.8%) patients. In these cases, before and after thrombolysis TCD fixed flow hypoperfusion. Mortality was 14.7%.Conclusions. Thrombolytic therapy is effective treatment for ischemic stroke, especially in the delivery of the patient to a hospital for the first 2 hours after the manifestation of clinical symptoms. The marker of effectiveness thrombolysis is registration on the CMA normoperfusion or hyperperfusion pattern. Good functional outcome marked when a patient achieved result ≤2 points on the mRS. Asymptomatic hemorrhagic transformation can also be considered as a marker of effective thrombolysis. The combination of a CT scan of the brain with transcranial Doppler allows to assess not only the size of the lesion of the brain, but also to investigate the nature of cerebral hemodynamics. Further development of a set of measures designed to raise awareness among the population and general practitioners about the symptoms of stroke and its effective treatment in the case of delivery of the patient to a specialized hospital in which is possible to conduct thrombolysis.