ISCHEMIC-REPERFUSION INJURY AFTER THROMBOLYTIC THERAPY FOR ISCHEMIC STROKE
Keywords:
ischemic stroke; systemic intravenous thrombolytic therapy; reperfusion syndrome, neurological deficitAbstract
A prospective study of 67 patients with ischemic stroke who underwent systemic thrombolytic therapy (ТLT) was conducted. Depending on the course of the post-reperfusion period, the patients were divided into two groups: the first group consisted of 48 patients who did not develop reperfusion syndrome, and the second group consisted of 19 patients with clinical manifestations of ischemia-reperfusion injury (IRI). In patients without IRI, a significant improvement in neurological status was observed already 24 hours after TLT: the level of consciousness according to the GCS increased from 10.3±1.2 to 13.8±1.2 points, reaching 14.1±0.9 points by the 7th day (p<0.005), while the NIHSS index decreased from 14.2±1.8 to 6.3±1.5 points after 24 hours and to 5.2±2.1 points by the 7th day (p<0.005). In contrast, patients with IRI experienced early clinical deterioration, accompanied by hyperthermia, worsening neurological deficits, impaired consciousness, seizures, and hemodynamic and respiratory distress. The GCS decreased from 10.6±2.4 to 9.3±3.5 points after 24 hours and was 10.1±4.5 points on day 7, while the NIHSS increased from 14.9±3.5 to 18.3±4.1 points after 24 hours and remained high (16.1±4.5 points) on day 7. The development of IRI after systemic TLT is associated with early neurological deterioration and unfavorable dynamics of clinical indicators, reflecting the progression of IRI of the brain.
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