Tesis doctoral de Montserrat González Delgado
Introduction: intravenous(iv) thrombolysis with recombinant tisular plasminogen activator (rt-pa) is the only approved treatment for the acute ischemic stroke. The cinical evolution after this treatment could be variable. patients(method: theaim of this study was to analyze the different clinical evolutions in patients 48 hours after iv thrombolysis trying to identify prognostic factors. We took four groups: patients remaining stable after treatment, without clinical changes or changes less than 4 points nihss (group i); patients with clinical improvement, or decrease >- 4 pints nihss (group 2); patients with clinical worsening, or increase >- 4 points in the nihss (group 3); and patients with worsening after initial improvement, or initial decrease >- 4 points nihss and posterior worsening>- 4 points nihss. We analyzed previous cerebrovascular risk factors (smoking, artrial hypertension, hyperlipemia cardiopathy…): Admission parmeters (glycemia, blood pressure…); Neuroimaging (basa ct, angio-ct and perfusion-ct) at admission and worsening: and clinical and functional status (nihss, bl and mrs). results/conclusions: beween january 2000- october 2005, 136 patients fulfilled crieria to iv thrombolysis (57 females, 79 males): 11,8% (group 1), 67% (group 2), 13% (group 3) and 8% (group 4). Of the patients with initial improvement, 10,8% had posterior worsening. The mechanism of stroke (toast criteria) was: 18% large vessel, 3% small vessel, 48% cardioembolic, 15% another actiology and 19% undetermined. Female sex, peripheral vascular disease and no hyperlipemia were associated at group 3. Tobacco and no valvulopathy were associated at group 2. No occlusion in the admission angio-tc and penumbra > core in the admission perfusion-ct were associated with better prognostic. Nevertheless 25% patients with penumbra> core had worsening after initial improvement. Persistent oclusion in angio-tc was associated with group 3. Causes of worsening were symptomatic intracranial haemorrhage (sich) (mortality rr igual 30), intracranial oedema (mortality rr igual 29) and reoclusion/new (mortality rr igual 4). Patients with sich had a mortality rr igual 9,6.In comparison to group 2, group 3 patients had a mortality rr igual 43,6, and group 4 had a mortality rr igual 14,7.
Datos académicos de la tesis doctoral «Evolución clínica tras el tratamiento trombolítico intravenoso con activador de recombinante del p.«
- Título de la tesis: Evolución clínica tras el tratamiento trombolítico intravenoso con activador de recombinante del p.
- Autor: Montserrat González Delgado
- Universidad: Oviedo
- Fecha de lectura de la tesis: 09/05/2008
Dirección y tribunal
- Director de la tesis
- Carlos Hernádez Lahoz
- Tribunal
- Presidente del tribunal: Miguel enrique del Valle soto
- tomás Segura martín (vocal)
- José álvarez sabín (vocal)
- Juan Francisco Arenillas lara (vocal)