Abstract
Two years has passed since thrombolytic therapy was approved for acute ischemic stroke with intravenous alteplase in Japan. Clinical results from 7 acute stroke centers in Fukuoka city demonstrated that the numbers of patients who admitted to those hospitals within 3 hours were not significantly increased. However, the numbers and the frequency of the patients treated with recombinant tissue plasminogen activator alteplase (rt-PA) were significantly increased during 2 years. We should enlighten the citizens what to do when they encounter or experience stroke, and should make close relationship and networks in each local emergency systems.
In Kyushu Medical Center, 33 patients (4% of acute brain infarction) were treated with rt-PA, of whom 18 patients were cardioembolic stroke. The patients with severe cardioembolism (NIHSS>15) and those with hypertension at onset tended to be worse outcome. Patients with aortic dissection should be diagnosed carefully, since they showed unexpected worse outcome after the rt-PA therapy. Clinical outcome of the patients with rt-PA in a post-marketing research did not reach the satisfactory level compared with that of J-ACT phase III study. Attendant doctors in some hospitals have not submitted the medical record documents sufficiently. Vascular neurologist should obey the indication for rt-PA therapy, and have the ability to assess early CT findings. Hyper-acute stroke patients should be treated in a standard stroke center with enough stroke specialist and staffs although many issues have not yet been solved.
