Real-World Effectiveness of Intravenous Stroke Thrombolysis is more than the Expectation of Practicing Neurologists

BACKGROUND: The objective of the study was to compare the actual results of intravenous thrombolytic therapy (IVTT) in acute ischemic stroke with results anticipated by neurologists in practice. METHODS: Neurologists practicing in Thrissur metropolitan region, covering a population of 1.8 million, were telephonically surveyed about the number of yearly IVTT and their expert opinion/comment about effects of thrombolysis. This was compared with the results of IVTT from a single institution in the same region from 2012 to 2016. RESULTS: Eight neurologists in the region give approximately 140–150 IVTT per year. Nearly 20%–40% (median 32%) patients have good outcome, 5%–10% (median 9%) have intracerebral hematoma (ICH), and 25%–35% (median 30%) have death/bad outcome. Two neurologists from a tertiary care hospital in the region treated 122 cases of ischemic strokes with IVTT from 2012 to 2016. Age ranged from 8 to 88 years and 88 were males. Average delay in reaching hospital was 138.1 min and the door-to-needle time was 56.3 min. There were 26 cases of posterior-circulation strokes and 14 cases of cardioembolic strokes. At presentation, average National Institute of Health Stroke Scale (NIHSS) was 14.7; Modified Rankin Scale (mRS) 0.4; and CT Alberta Stroke Program Early Computerized Tomography Scores was 9.5. Good and sustained benefit (GSB) (>4 reduction in NIHSS at 24 h and 7 days) was there in 49% and no improvement (NI)/worsening in 36%. mRS 0–2 at discharge/30 days was documented in 57.3%. Symptomatic ICH was 10% (12/122) and mortality rate was 11.5% (14/122). GSB in posterior circulation strokes was 69.2% and NI/worsening in only 7.7%. mRS was 0–2 in 77% of posterior circulation strokes. CONCLUSION: Contrary to the popular belief of the practicing neurologists, IVTT has a high percentage of good outcome with a reasonable bleeding risk and low rates of absolute futility.