Purpose: To evaluate thrombolytic therapy with rt-PA for acute stroke within 6h of symptom onset, and assessment of neurologic outcome.
Methods: We studied 6 patients, four women, mean age 63 +/- 18 years, with severe neurologic deficit within 6h of stroke onset, and with no spontaneous improvement. The stroke was embolic in 3, and thrombotic in the others. All patients were submitted to a head CT scan followed by either a cerebral angiography in 3 patients, or a transcranial Doppler, in the other 3 for assessment of arterial obstruction, and patency after thrombolytic therapy. We used 0.9 mg/kg of rt-PA, IV, over 60 min in 5 patients, and 0.5 mg/kg by intra-arterial infusion, over 60 min, in one. At the beginning a bolus of 10% of the total dose was delivered during 1 to 2 min. Head scan was repeated 24h and 7 days after treatment to detect ischemic areas and hemorrhagic complications.
Results: Middle cerebral artery occlusion was observed in 5 patients and posterior cerebral artery occlusion in one. The obstruction was cleared in 4 patients with persistence of the patency after 24h. A complete neurologic recovery was found in one patient, and a partial recovery in three. In two patients there was failure of arterial recanalization with no neurologic recovery. Only one patient had hemorrhagic transformation of ischemic tissue, without neurologic worsening. Death occurred in one patient due to pulmonary infection.
Conclusion: Arterial patency with thrombolytic therapy was effective in 4 of our 6 patients. All 4 patients also disclosed a certain degree of neurologic improvement, rt-PA can be successfully used in selected patients up to 3h of the event onset, as shown in randomized studies.