Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study

Murat Mert Atmaca; Özcan Kocatürk; Fidan Marufoğlu; Ahmet Candan Köylüoğlu; Melek Çolak Atmaca; Metin Balduz; Ayşenur Önalan; Emine Kargı

doi:10.4274/tnd.2018.69335

Murat Mert Atmaca¹, Özcan Kocatürk², Fidan Marufoğlu¹, Ahmet Candan Köylüoğlu¹, Melek Çolak Atmaca¹, Metin Balduz¹, Ayşenur Önalan¹, Emine Kargı¹

¹Mehmet Akif Inan Training and Research Hospital, Clinic of Neurology, Sanliurfa, Turkey
²Harran University Research and Practice Hospital, Department of Neurology, Sanliurfa, Turkey

Keywords: Acute ischemic stroke, intravenous thrombolytic treatment, outcome

Abstract

Objective: Stroke ranks second among the diseases that cause death and third among the causes of disability in Turkey. An average of 1.9 million neurons die every minute due to acute ischemic stroke and therefore ‘time is brain’. Intravenous thrombolytic treatment (ITT) and, if possible, endovascular treatment should be initiated quickly. We aimed to share our ITT experience in Sanliurfa with this study.

Materials and Methods: We recorded the clinical and demographic characteristics, risk factors, and three-month follow-up of 21 patients with acute ischemic stroke who were given ITT between June 2015 and July 2017.

Results: Of the 21 patients, nine were male and 12 were female, and the mean age was 72.1±11.8 (range, 48-87) years. Large vessel occlusion was found in five (23.8%) patients, cardioembolism in 9 (42.9%), and small vessel occlusion in 2 (9.5%) patients; etiology was not determined in five (23.8%) patients. Atrial fibrillation was found in 38.1%, hypertension in 57.1%, diabetes mellitus in 23.8%, coronary artery disease in 33.3%, hyperlipidemia in 19%, and smoking in 33.3% of the patients.The NIHSS score was 11.7±6.7 (range, 2-24) prior to treatment. The symptom-onset to needle time was 185±55.8 minutes when 19 patients were evaluated. Intracerebral hemorrhage was observed in two (9.5%) patients after treatment. One patient was asymptomatic and the symptomatic patient (4.75%) died despite decompression surgery. Ten patients died and the mortality rate was 47.6% at the end of the three-month follow-up period. The modified Rankin scale score was 0-2 in eight patients (38.1%) and was 0-1 in seven patients (33.3%). ITT was given to seven patients aged ≥80 years, five patients with NIHSS <5, and two patients in whom the treatment window was exceeded, which was non-adherent to the label.

Conclusion: ITT is effective and safe. It increases the number of independent living patients. We must strive to perform this treatment all over Turkey and encourage our colleagues.