Introduction: Stroke is a major medical and social problem both worldwide
and in the Republic of Moldova. According to the National Centre of Health
Management during the years 2000-2014 there was a continuous elevation of
incidence and prevalence of cerebrovascular diseases per 10.000 population. The
general incidence raised from 20,4 in 2000 to 26,82 in 2014; the prevalence index

in the general population reached 199,08 in 2014 compared to 67,0 in 2000; this
dynamic led to an increase in the number of deaths due to stroke in recent years,
cerebrovascular diseases ranking second place in the total number of deaths per
year. Starting with 2005, our clinic has used intravenous thrombolysis as treatment
of eligible patients with acute ischemic stroke. Our aim was to assess the efficacy
and safety of intravenous thrombolysis with rtPA in treatment of patients with acute
ischemic stroke and compare the results to those provided by the international
community.
Methods: 40 patients diagnosed with acute ischemic stroke treated at the Institute
of Emergency Medicine during the period November 10, 2015 - April 30, 2016 and
followed up for one month after hospital discharge. Analyzed data included: time
from onset of symptoms; time till arrival to the emergency department; time till
brain CT; till rtPA administration (door to needle time); presence of intracerebral
arteries occlusion before and after rtPA administration and its correlation to NIHSS
score; recanalization rate after rtPA; presence of symptomatic or asymptomatic
intracerebral hemorrhage after treatment with rtPA at 24h and hospital discharge;
number of days in the ICU; total inpatient treatment duration; mRS at admission
and hospital discharge. Other registered parameters were: demographic profile,
stroke risk factors, blood pressure values and basic observations found at brain CT.
Patients with medical history of decompensated cardiac, renal, hepatic pathologies
were excluded. The solution of rtPA was administered at a dose of 0.9 mg / kg.
Results: All 40 patients diagnosed with acute ischemic stroke were classified
according to TOAST criteria (atherosclerosis of a major artery - 7; cardioembolic - 8;
lacunar - 12; other determined etiology - 0; unclear etiology - 13). Among them 21
were men and 19 women; average age - 62 years old. Average time of arrival to the
emergency department was - 90 min (max - 195; min - 9); average time required
to perform CT - 47.45 min (max - 129; min - 20); time to rtPA infusion - 114.6
min (max - 233; min - 75). NIHSS score at admission ranged from 6 to 18 points.
Associated diseases: Arterial hypertension - 36 patients (90%), Diabetes mellitus -
6 patients (15%), Hypercholesterolemia - 21 patients (52.5%), Atrial fibrillation - 21
patients (52.5%), History of stroke - 3 patients (7.5%), Heart failure - 17 patients
(42.5%), Ischemic heart disease - 13 patients (32.5%), Smoking - 3 patients (7.5%).
Signs of cerebral artery occlusion were found in 20 cases (50%), average NIHSS
score at admission in these patients being 14p. Signs of recanalization after the
administration of rtPA were observed in 12 patients (60% of those with occlusion)
average NIHSS score at last day of follow up was 7 points. Patients with poor
recanalization rate had an average NIHSS score of 6 points at last day of follow up.
More detailed results are provided in the publication paper.

Conclusion: Intravenous thrombolytic therapy within the first 3-4,5 hours
of ischemic stroke onset offers substantial net benefits for almost all patients
with potentially disabling deficits, nevertheless detailed inclusion/exclusion
criteria should be analyzed and an individualized decision is ought to be made.
Further investigations are needed in order to determine the correlations between
recanalization rate and patient’s outcome after intravenous rtPA treatment.