Early functional outcome after IV rTPA administration in Egyptian acute ischemic stroke patients

Abstract

Background: Intravenous thrombolysis has become a standard practice in eligible patients with acute ischemic stroke (AIS). Functional outcome after AIS is a major concern for patients, families, and neurologists. Identifying factors affecting the early functional outcome and the effect of IV rTPA in Egyptian AIS patients is crucial to address concerns and queries. Objectives: Compare functional outcome between AIS patients treated with and without IV rTPA and to study clinical predictors of outcome. Methods: This study was performed on AIS within 24 h of symptom onset. Patients were dichotomized into group I, patients who received IV rTPA, and group II, patients who had contraindication to it. Patients were assessed with NIHSS and mRS at 3 months. The functional outcome was studied in relation to risk factors, TOAST classification, OSCP classification, and NIHSS severity. Results: In mild stroke: group I showed better 7-day NIHSS and 3-month mRs, when compared to group II, (P 0.002, 0.089 respectively). In group I, 68.6% of patients with total anterior circulation syndrome (TACS) had unfavorable outcome (P = 0.004). Those with lacunar syndrome, 78.6% had favorable outcome (P = 0.0162). In group I, there was a positive correlation between 3-month mRs and age, NIHSS on admission, and NIHSS at 7 days (P 0.017, < 0.001, < 0.001, respectively). Conclusion: Age and NIHSS at admission were correlated with poor outcome at 3 months in the IV rTPA group. Better functional outcome was observed in thrombolysed patients in groups with mild stroke severity. The study showed that patients with TACS had the most unfavorable outcome, while lacunar infarction patients had the most favorable outcome.