Background: Intravenous thrombolysis with alteplase is the only approved treatment for acute ischemic stroke. But there are patients with a severe stroke who do not benefit much from intravenous thrombolysis compared with patients having a mild to moderate severe stroke. We want to see if there is a significant difference in gaining recovery between those who get mild stroke and those who get severe stroke.
Methods: Analysis of a thrombolysis- register ”SITS-MOST” (safe Implementation of Trombolysis in Stroke- Monitoring Study) from the period between 2003-01-01 and 2009-02-17 at Akerhus Universitets sykehus, Norway. Patients were evaluated with Rankin scale before getting stroke. At the point of stroke, patients were evaluated with NIHSS, TOAST- and Oxford classification. After getting thrombolysis, NIHSS was measured after 2 hours, 24 hours and after 7 days. Their function was monitored again after 3 months using Rankin scale.
Results: After giving thrombolysis the outcome after 24 hours was as follows: in the NIHSS =< 10 group 48% had been much better, 19% had been worse, and nobody had died yet. In the NIHSS > 10 group 43% had been much better, 10% had been worse, and nobody were died. Outcome after 3 months by using Rankin scale was as follow: In the NIHSS group =< 10, 13% had no symptoms, 30% had mild dysfunction, 13% had moderate difficulties, and 3% were died. Compared with the NIHSS > 10 group, 4% had no symptoms, 32 % had mild dysfunction, 29% moderate difficulties, and 7% were died after 3 months.
Conclusions: Our results confirm that a NIHS score over 10 after giving intravenous thrombolysis is associated with a poorer outcome compared with those with a NIH score below 10. The findings should encourage use of intraarterial thrombolytic therapy for suitable patients treated in stroke centres.