Personification of the approaches to reperfusion therapy of ischemic stroke

Abstract

Introduction. Systemic thrombolytic therapy using recombinant tissue plasminogen activator (rtPA) is the gold standard of reperfusion therapy in certainpatients with ischemic stroke during the first 4.5 h after stroke onset. Objective. To assess the clinical (severity of neurological symptoms) and laboratory (complete blood cell count test) factors that affect the disease prognosis aftersystemic thrombolytic therapy. Materials and methods. Seventy patients (48 males and 22 females) aged 61 [54; 69] years with ischemic stroke who received systemic thrombolytic therapy withrtPA at a dose of 0.9 mg/kg were prospectively studied. Blood for the complete blood count test including neutrophil and lymphocyte counts was sampled before thethrombolytic therapy. The severity of neurological impairment was assessed using the NIH Stroke Scale. The functional prognosis was assessed 3 months afterstroke using the modified Rankin scale (mRS). Markers for the unfavorable prognosis of the acute phase of ischemic stroke (mRS score 3) were revealed by ROCanalysis involving sensitivity and specificity determination. Results. Severity of neurological symptoms assessed using the NIH scale at admission was 15 [11; 17] points. Time between the manifestation of neurologicalsymptoms and admission to the hospital was 138 [117; 170] min; between admission and initiation of systemic thrombolytic therapy (the door-to-needle time),40 [30; 55] min. An unfavourable functional outcome of systemic thrombolytic therapy can be predicted according to the results of ROC analysis: the NIH score upon admissionbeing 12 or higher (sensitivity, 94%; specificity, 57%); neutrophil count, 7.8109/L (sensitivity, 45.5%; specificity, 90.6%); lymphocyte count, 1.8109/L(sensitivity, 81.8%; specificity, 59.4%). Conclusions. The customized approach to systemic thrombolytic therapy can help predict its effectiveness and contribute to elaboration of adequate approachesto patient management. Patients with a potentially unfavourable prognosis for systemic thrombolysis can be the target group for using mechanical reperfusiontechniques such as thrombus extraction.

Keywords

• stroke
• systemic thrombolysis
• predictors