Intravenous thrombolysis with rt-PA for acute ischemic stroke within 24h of a transient ischemic attack

BACKGROUND Intravenous thrombolysis (iv-thrombolysis) with the use of rt-PA in patients after recent transient ischemic attack (TIA) is an important clinical problem. The aim of the study was to assess the impact of TIA within 24h preceding acute ischemic stroke (AIS) on the safety and efficacy of iv-thrombolysis. METHODS We retrospectively evaluated the clinical and demographic data of 400 patients with AIS who were consecutively treated with iv-thrombolysis from September 2006 to May 2011 in three stroke centers. RESULTS At three-month follow-up, 58.0% of patients were independent (modified Rankin scale; mRS 0-2), 17.8% had died, 17.0% suffered hemorrhagic transformation (HT) and 4.3% experienced symptomatic intracerebral hemorrhage (SICH). There were 29 patients (7.3%) who had a previous ipsilateral TIA within 24h before established stroke. In the TIA subgroup, there was no significant higher percentage of favorable outcome (p=0.07) and higher SICH rate (p=0.15). Multivariate analysis showed the impact of prior TIA within 24h before stroke onset in the presence of SICH (p=0.01), no impact of TIA on unfavorable outcomes after three months (p=0.25) and on the mortality rate within three months (p=0.41). CONCLUSION TIA within 24h prior to ischemic stroke can portend severe intracerebral bleeding in patients qualified to iv-thrombolysis with the use of rt-PA.