Post-licensed 1-year experience of systemic thrombolysis with tissue plasminogen activator for ischemic stroke in a Japanese neuro-unit

被引:27
作者
Yoneda, Yukihiro
Yamamoto, Shinji
Hara, Yoshie
Ohta, Kohei
Matsushita, Makoto
Yamamoto, Daisuke
Yamashita, Haruo
Hosoda, Kohkichi
机构
[1] Kobe Red Cross Hosp, Div Neurol, Kobe, Hyogo 6510073, Japan
[2] Hyogo Emergency Med Ctr, Div Neurosurg, Kobe, Hyogo 6510073, Japan
[3] Kobe Univ, Grad Sch Med, Dept Neurosurg, Kobe, Hyogo 657, Japan
关键词
Asia; Japan; stroke; thrombolysis; tissue plasminogen activator;
D O I
10.1016/j.clineuro.2007.05.002
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: In Japan, intravenous thrombolysis with tissue plasminogen activator (tPA) for ischemic stroke within 3 h of onset was officially approved in October 2005. Methods: We report initial 1-year clinical experience of intravenous alteplase at 0.6 mg/kg in a Japanese neuro-unit. Results: Twenty patients received intravenous tPA, corresponding to 12% of all ischemic strokes (n =166) and 38% of ischemic strokes within 3 h of onset (n =52). The mean age was 68 years old and 15% had pre-morbid dependency with modified Rankin Scale (mRS) of 3 or 4. The median baseline National Institute of Health Stroke Scale score was 19 points (range; 5-37). Average time from stroke onset to tPA delivery was 136 min (range; 87-180). Of 18 (90%) patients receiving pretreatment vascular imaging, 16 (80%) patients had a large arterial occlusion. At 3 months, excellent outcome with mRS of 0 or 1 was 25%, and good outcome with mRS of 0-2 was 35%. One patient (5%) developed symptomatic intracranial hemorrhage within 36 h. Mortality rate was 15%. Conclusions: Intravenous tPA within 3 It was safe and feasible, and possibly effective in clinical practice. The higher stroke severity in our cohort precluded to compare the sufficient effectiveness with clinical trials. In Japan, a post-licensed national surveillance is currently under way. (c) 2007 Elsevier B.V. All rights reserved.
引用
收藏
页码:567 / 570
页数:4
相关论文
共 14 条
[1]   Intravenous tissue-type plasminogen activator for treatment of acute stroke - The standard treatment with alteplase to reverse stroke (STARS) study [J].
Albers, GW ;
Bates, VE ;
Clark, WM ;
Bell, R ;
Verro, P ;
Hamilton, SA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 283 (09) :1145-1150
[2]   Intravenous tissue plasminogen activator for acute ischemic stroke: Feasibility, safety, and efficacy in the first year of clinical practice [J].
Chiu, D ;
Krieger, D ;
Villar-Cordova, C ;
Kasner, SE ;
Morgenstern, B ;
Bratina, PL ;
Yatsu, FM ;
Grotta, JC .
STROKE, 1998, 29 (01) :303-303
[3]   Predictors of good outcome after intravenous tPA for acute ischemic stroke [J].
Demchuk, AM ;
Tanne, D ;
Hill, MD ;
Kasner, SE ;
Hanson, S ;
Grond, M ;
Levine, SR .
NEUROLOGY, 2001, 57 (03) :474-480
[4]   Early intravenous thrombolysis for acute ischemic stroke in a community-based approach [J].
Grond, M ;
Stenzel, C ;
Schmülling, S ;
Rudolf, J ;
Neveling, M ;
Lechleuthner, A ;
Schneweis, S ;
Heiss, WD .
STROKE, 1998, 29 (08) :1544-1549
[5]   European Stroke Initiative Recommendations for Stroke Management - Update 2003 [J].
Hacke, W .
CEREBROVASCULAR DISEASES, 2003, 16 (04) :311-337
[6]  
Hacke W, 2004, LANCET, V363, P768
[7]   Early recanalization after intravenous administration of recombinant tissue plasminogen activator as assessed by pre- and post-thrombolytic angiography in acute ischemic stroke patients [J].
Lee, Kyung-Yul ;
Han, Sang Won ;
Kim, Seo Hyun ;
Nam, Hyo Seok ;
Ahn, Sung Whan ;
Kim, Dong Joon ;
Seo, Sang Hyun ;
Kim, Dong Ik ;
Heo, Ji Hoe .
STROKE, 2007, 38 (01) :192-193
[8]   Long-term outcome after intravenous thrombolysis of basilar artery occlusion [J].
Lindsberg, PJ ;
Soinne, L ;
Tatlisumak, T ;
Roine, RO ;
Kallela, M ;
Häppölä, O ;
Kaste, M .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 292 (15) :1862-1866
[9]   Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator [J].
Linfante, I ;
Llinas, RH ;
Selim, M ;
Chaves, C ;
Kumar, S ;
Parker, RA ;
Caplan, LR ;
Schlaug, G .
STROKE, 2002, 33 (08) :2066-2071
[10]   TISSUE-PLASMINOGEN ACTIVATOR FOR ACUTE ISCHEMIC STROKE [J].
MARLER, JR ;
BROTT, T ;
BRODERICK, J ;
KOTHARI, R ;
ODONOGHUE, M ;
BARSAN, W ;
TOMSICK, T ;
SPILKER, J ;
MILLER, R ;
SAUERBECK, L ;
JARRELL, J ;
KELLY, J ;
PERKINS, T ;
MCDONALD, T ;
RORICK, M ;
HICKEY, C ;
ARMITAGE, J ;
PERRY, C ;
THALINGER, K ;
RHUDE, R ;
SCHILL, J ;
BECKER, PS ;
HEATH, RS ;
ADAMS, D ;
REED, R ;
KLEI, M ;
HUGHES, S ;
ANTHONY, J ;
BAUDENDISTEL, D ;
ZADICOFF, C ;
RYMER, M ;
BETTINGER, I ;
LAUBINGER, P ;
SCHMERLER, M ;
MEIROSE, G ;
LYDEN, P ;
RAPP, K ;
BABCOCK, T ;
DAUM, P ;
PERSONA, D ;
BRODY, M ;
JACKSON, C ;
LEWIS, S ;
LISS, J ;
MAHDAVI, Z ;
ROTHROCK, J ;
TOM, T ;
ZWEIFLER, R ;
DUNFORD, J ;
ZIVIN, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (24) :1581-1587