Early Recurrent Ischemic Stroke in Stroke Patients Undergoing Intravenous Thrombolysis

Author:

Georgiadis Dimitrios1,Engelter Stefan1,Tettenborn Barbara1,Hungerbühler Hansjörg1,Luethy Regina1,Müller Felix1,Arnold Marcel1,Giambarba Christian1,Baumann Christian Rainer1,von Büdingen Hans-Christian1,Lyrer Philipp1,Baumgartner Ralf Werner1

Affiliation:

1. From the Departments of Neurology, Universities of Zürich (D.G., C.R.B., H.-C.v.B., R.W.B.) and of Basel (S.E., P.L.); the Departments of Neurology, District Hospitals of St Gallen (B.T.) and of Aarau (H.H., C.B.); the Department of Internal Medicine (R.L.), District Hospital of Triemli; the Department of Neurology (F.M.), District Hospital of Thurgau (Münsterlingen); the Department of Neurology (M.A.), University of Bern; and the Department of Internal Medicine (C.G.), District Hospital of Waid,...

Abstract

Background— We assessed the incidence of early recurrent ischemic stroke in stroke patients treated with intravenous tissue-type plasminogen activator (tPA) and the temporal pattern of its occurrence compared with symptomatic intracranial hemorrhage (ICH). Methods and Results— Prospectively collected, population-based data for 341 consecutive acute stroke patients (62% men; mean age, 66 years) treated with tPA according to the National Institute of Neurological Disorders and Stroke study protocol at 8 medical centers in Switzerland (3 academic and 5 community) between January 2001 and November 2004 were retrospectively analyzed. The primary outcome measure was neurological deterioration ≥4 points on the National Institutes of Health Stroke Scale occurring within 24 hours of tPA treatment and caused either by recurrent ischemic stroke (defined as the occurrence of new neurological symptoms suggesting involvement of initially unaffected vascular territories and evidence of corresponding ischemic lesions on cranial computed tomography scans, in the absence of ICH) or by ICH. Early recurrent ischemic stroke was diagnosed in 2 patients (0.59%; 95% confidence interval, 0.07% to 2.10%) and symptomatic ICH in 15 patients (4.40%; 95% confidence interval, 2.48% to 7.15%). Both recurrent ischemic strokes occurred during thrombolysis, whereas symptomatic ICHs occurred 2 to 22 hours after termination of tPA infusion. Conclusions— Recurrent ischemic stroke is a rare cause of early neurological deterioration in acute stroke patients undergoing intravenous thrombolysis, with a different temporal pattern compared with that of symptomatic ICH.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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