Dear Editor,

It is well known that thrombolysis with intravenous recombinant tissue plasminogen activator (rt-PA) is the first evidence-based treatment for acute ischemic stroke. In the European Union (EU), rt-PA was approved in 2002 and has been used widely since then. Bosnia and Herzegovina is one of the few European countries not yet part of the EU, and approval for rt-PA in acute ischemic stroke was granted in 2007 under the same conditions as in other European countries.

We presented our results with the use of intravenous thrombolytic therapy in patients with acute ischemic stroke in Tuzla Canton, Bosnia and Herzegovina. Between April 2008 and December 2011, intravenous rt-PA was administered to 72 patients with acute ischemic stroke, which represents 3·5% of patients with acute ischemic stroke admitted to the Department of Neurology Tuzla in that period (2067 patients). Baseline characteristics of the patients treated with thrombolytic therapy are provided in Table 1.

Table 1. Baseline characteristics of the patients treated with thrombolytic therapy
  1. NIHSS, National Institute of Health Stroke Scale; ICH, intracerebral hemorrhage; SD, standard deviation.

Female, n (%)26 (36)
Male, n (%)46 (64)
Age (y), mean ± SD64 ± 10
Stroke risk factors, n (%) 
Hypertension53 (74)
Diabetes mellitus22 (31)
Atrial fibrillation20 (28)
Heart failure12 (17)
Hyperlipidemia16 (22)
Current smoking25 (35)
Previous stroke6 (8)
Baseline NIHSS, n (%) 
0–713 (18)
8–1437 (52)
≥ 1522 (30)
NIHSS, mean ± SD12 ± 4·5
Stroke etiology, n (%) 
Large artery arteriosclerosis33 (46)
Cardiac embolism14 (19)
Lacunar stroke15 (21)
Undetermined10 (14)
Door-to-needle time (mean)74 min.
Onset-to-needle time (mean)154 min.
Significant ICH, n (%)4 (5·5)

Figure 1 illustrates the three-month outcome of our patients treated with thrombolytic therapy in comparison with the results of the neighboring countries: Sestre milosrdnice University Hospital Zagreb, Croatia [1] and Institute of Neurology Belgrade, Serbia [2].


Figure 1. Three-month outcome of the patients treated with thrombolytic therapy

mRS, modified Rankin Score.

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We wish to emphasize that these are only the results from our department, not at the national level. Bosnia and Herzegovina is one of the few countries in Europe that does not have an official National Stroke register, primarily because of the political situation. Therefore, our participation in multicenter studies is limited. With this article we want to demonstrate that we are working in line with the established protocols and show that our results are approximate to the results of other countries, despite the aforementioned shortcomings. These are small steps for world's neurology but big ones for neurology in Bosnia and Herzegovina.


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  2. References
  • 1
    Roje-Bedekovic M, Vargek-Solter V, Coric L et al. Thrombolysis for acute ischemic stroke – our experiences as part of SITS-MOST. Acta Clin Croat 2009; 48:287293.
  • 2
    Bogosavljevic V, Bodenant M, Beslac-Bumbasirevic LJ et al. Intravenous thrombolysis for acute cerebral ischemia in Belgrade, Serbia: comparison with Lille, France. Eur Neurol 2011; 66:3036.