Abstract Body: Introduction
Treatment of acute stroke has its clear rules and established standards. However, in the case of a very early recurrence, the situation is unclear, there is no clear recommendation and the options are limited. We present the results of a multicenter retrospective study using prolonged low-dose intravenous thrombolysis.
Methods
The multicenter retrospective study ESR_PROLONG (2020-2024) included consecutive patients who were given intravenous thrombolysis (20 mg alteplase continuously for 10 hours) during an early (within hours after standard recanalization therapy) recurrence of ischemic stroke. The clinical status was evaluated according to the NIHSS (National Institutes of Health Stroke Scale) at the time of recurrence and the day after the application of rescue therapy, and further according to the mRS (modified Rankin Scale) at an interval of 90 days. The safety of the treatment was evaluated based on the occurrence of any complications, the occurrence of intracerebral hemorrhage, and the occurrence of symptomatic intracerebral hemorrhage (assessed according to SITS-MOST criteria).
Results
44 patients were enrolled in 4 centers (45.5% men, average age 71.5±12.2 years). The neurological deficit corresponded to 5 points in the median NIHSS after a previous stroke, 11 points at the time of recurrence, and 7 points after rescue therapy. Improvement occurred in 70.5% of patients. A good clinical outcome (mRS 90day ≤2) was achieved by 61.4%. Mortality was 15.9%. The incidence of intracerebral hemorrhage was 9.1% and we did not observe symptomatic intracerebral hemorrhage. There were also no other complications.
Conclusion
Rescue therapy in the form of prolonged low-dose thrombolysis seems to be an effective and safe alternative to therapeutic nihilism in ultra-early stroke recurrence. Data from a randomized trial would significantly contribute to confirming the results.