Authors
Leonov G. M.
Doctor of Medicine, Assistant Professor, Chair for Neurology and Neurosurgery1
Sorokin O. À.
Neurologist, Head, Intensive Care and Resuscitation Department for Patients with Acute Cerebrovascular Problems2
Solomatina À. S.
6th Year Student of The Medical Faculty1
1 - Ryazan state medical University named after akad. I. P. Pavlov, Ryazan, Russia
2 - Regional clinical hospital, Ryazan, Russia
Corresponding Author
Solomatina Anastasia; e-mail: nastya.solomatina2017@yandex.ru
Conflict of interest
None declared.
Funding
The study had no sponsorship.
Abstract
The problem of cerebral ischemic stroke (IS) is of extreme medical and social importance due to the significant frequency of its development, high percentage of resulting disability and mortality. Thrombolytic therapy (TLT) is currently the only possibility of highly effective intervention, allowing to restore blood flow in the affected vessel and prevent irreversible changes in brain tissue. To evaluate the effectiveness of TLT by recombinant tissue plasminogene activator (rt-PA) Alteplase* (Alteplase*), a retrospective analysis of 103 case histories of patients in the acute period of IS receiving TLT in the first 4.5 hours was carried out. The evaluation considered the data of neurological examination on the NIHSS score scale: at admission, 1 hour after the start of thrombolytic administration and a day after, as well as the frequency of detection of hemorrhagic transformation (HT) on brain tomography. To compare the average values of quantitative traits in the two groups, the Student's t-test was used in case of normal distribution (verified by Kolmogorov-Smirnov test). When comparing frequencies and fractions, statistical differences were established by calculating Pearson's Chi-square (χ2). For each studied parameter we calculated: M-mean, SD-standard deviation, presented in the text as M ± SD (with normal distribution of variables). In all statistical analysis procedures, the achieved level of significance was calculated (p=0.05). Confidence intervals (CI) were constructed for the confidence probability p=95%. When assessing the neurological status on the NIHSS scale, the mean score for admission was 13.72±4.96 CI [13.43-13.96], p=0.227, and 24 h after TLT – 9.91±6.95 CI [9.67-10.21], p=0.141. The data of two dependent samples were processed using Student's t-test, p<0.001. As a result, statistically significant differences in the dynamics of neurological status were revealed. On average, the positive effect of TLT was observed in 38.1% of patients, and complications in the form of HT in 17.6%. It should be emphasized that TLT was performed in a much smaller number of patients than the recommended indicator. This is primarily due to the large number of contraindications and low hospitalization of patients during the «therapeutic window». TLT is an effective and safe method of reperfusion tera-FDI of the acute period of IS. However, despite the positive experience, there is still a high risk of HT, which is the leading cause of deaths.
Key words
ischemic stroke, thrombolytic therapy, recombinant fabric activator of a plasminogen, hemorrhagic transformation
DOI
References
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