Efficacy and safety of intravenous thrombolysis or bridging therapy for acute minor ischemic stroke with large artery occlusion / 第二军医大学学报

ABSTRACT

Objective To explore the efficacy and safety of intravenous thrombolysis or bridging therapy for acute minor ischemic stroke (MIS) with large artery occlusion. Methods Seventy-three acute MIS patients with large artery occlusion, who admitted to our hospital via stroke green channel within 4.5 h after onset from Sep. 2013 to Jun. 2018, were enrolled in this study, including 55 cases in intravenous thrombolysis group and 18 cases in bridging therapy group. The patients in the intravenous thrombolysis group underwent intravenous thrombolysis treatment with recombinant tissue plasminogen activator (rt-PA), and the patients in the bridging therapy group underwent thrombectomy within time window after intravenous thrombolysis. National Institutes of Health stroke scale (NIHSS) score at admission and modified Rankin scale (mRS) score at 90 days after treatment were evaluated in all patients. The mRS scoring 0-2 was good prognosis, and 3-6 was poor prognosis. Results There were no significant differences in the gender, age, medical history, smoking history, ratio of asymptomatic cerebral infarction, NIHSS score at admission, Glasgow coma scale score, Alberta stroke program early conputed tomography score, door-to-needle time or onset-to-needle time between the two groups (all P>0.05). The rates of good prognosis at 7 d and 90 d after treatment, incidence of symptomatic intracranial hemorrhage and mortality were not significantly different between the two groups (all P>0.05), while the incidence of systemic complications was significantly lower in the intravenous thrombolysis group than that in the bridging therapy group (23.6% [13/55] vs 44.4% [8/18]; χ2=2.434, P=0.019). Conclusion Intravenous thrombolysis and bridging therapy have similar clinical efficacy and safety in treatment of acute MIS with large artery occlusion; although the incidence of systemic complications in patients with bridging therapy is higher than that in patients treated with intravenous thrombolysis, the long-term effects are both good.