Use of thrombolytic therapy for treatment of stroke with ischemic type within the standard therapeutic window

Abstract

The study focuses on stroke, the second leading cause of death worldwide. It specifically addresses the ischemic type of stroke, which constitutes the majority of cases globally and in Ukraine, driving the search for innovative and effective diagnostic and treatment strategies. Among these, reperfusion of brain tissue within the first hours of the disease can prevent irreversible brain damage or minimize its extent, thus reducing the degree of residual neurological deficit. Objective — to compare the outcomes between standard therapy and thrombolytic therapy (TT) in treating ischemic stroke, evaluating the efficacy of TT within the standard therapeutic window to optimize patient care. Materials and methods. The study was conducted in the Neurological Department No. 2 of Kyiv City Clinical Hospital No. 4 from July to December 2023. A total of 247 cases of ischemic type stroke were analyzed. 69 patients who were admitted within the standard therapeutic window were selected. They were divided into two groups. The experimental group included 42 patients aged between 42 and 89 years (average age — (71.0 ± 17.8) years) without contraindications, who agreed (themselves or through relative’s consent) to undergo TT. Alteplase was administered intravenously at a dose of 0.9 mg/kg body weight, 10 % of the dose as a bolus (over 1 minute), and 90 % within one hour. The control group consisted of 27 patients aged between 47 and 88 years (average age — (76.11 ± 8.9) years), who had contraindications for TT. They received standard therapy. Evaluations were conducted using the modified Rankin Scale, which allows for assessing the level of disability or dependence on external assistance in patients’ daily lives after a stroke. Results. The study demonstrated that TLT significantly improves the functional status of patients compared to standard therapy, as evidenced by a decrease in the level of disability to 0—1 points on the modified Rankin Scale at discharge from the hospital: in the control group — in 3 (11.1 %) patients, in the experimental group — in 16 (35.7 %, p = 0.047), i. e. the use of TLT significantly improved the functional status of more patients. In the experimental group, 4 patients died (9.5 %), in the control group — 5 (18.5 %). Conclusions. TLT effectively promotes the restoration of neurological functions and reduces the level of disability in patients with ischaemic cerebral stroke, which opens up prospects for further research. The results obtained indicate the need for wider use of TLT in clinical practice, taking into account individual patient risks and contraindications.