Efficacy analysis of intravenous thrombolysis in patients with mild ischemic stroke / 中国脑血管病杂志

ABSTRACT

Objective: To investigate the effectiveness and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with minor ischemic stroke. Methods: From April 2016 to January 2018, 117 consecutive patients with acute mild cerebral infarction admitted to the Department of Neurology, Guangzhou First People's Hospital were enrolled retrospectively. Their onset was 0. 05). In the intravenous thrombolysis group, the time from onset to thrombolysis was 75-260 min,and the median time was 161.5 (129.5,185.0) min. (2) There were no significant differences in the NIHSS scores at 24 h and 7 d after treatment between the two groups (P>0.05). Among the patients with good prognosis at 90 d of intravenous thrombolysis,9/10 had good prognosis in patients with disabled stroke symptom and 81.5% (44/54) had good prognosis in those with non-disabled stroke symptom. There was no significant difference in the proportion of good prognosis between the two groups (P =0.512). Among the non-intravenous thrombolysis group with good prognosis at 90 d,8/12 had good prognosis in patients with disabled stroke, and the good prognosis rate in those with non-disabling stroke was 65. 9% (27/41). There was no significant difference in the proportion of good prognosis (P =0.413). The good prognosis rate of the intravenous thrombolytic group at 90 d was higher than that of the non-intravenous thrombolysis group. The difference between the groups was statistically significant (82.8% [53/64] vs. 66. 0% [35/53],χ2 =4. 376,P = 0. 036). (3) In the intravenous thrombolysis group, two patients developed intracerebral hemorrhage transformation during the treatment period;one patient stopped anti-platelet aggregation treatment because of hemorrhage in other parts; one died of intracranial hemorrhage after thrombolytic bridging of cerebrovascular thrombectomy. There were no bleeding and death events during the treatment in the non-intravenous thrombolysis group. There were no significant differences in the incidence of intracerebral hemorrhage transformation and mortality between the two groups (P>0.05). (4) The symptoms in three patients in the intravenous thrombolysis group aggravated, they were treated with the bridge mechanical thrombectomy. Two of them were assessed as non-disabled stroke before thrombolysis, and one patient with carotid artery stenosis underwent carotid artery stent implantation during hospitalization. In the non-intravenous thrombolysis group, 1 patient underwent carotid artery stent implantation and 1 underwent right middle cerebral artery Ml stent implantation. There was no significant difference in the incidence of intracranial macrovascular stenosis, extracranial macrovascular stenosis and total stenosis rate between the two groups (P>0.05). Conclusion: Intravenous thrombolysis is safe and effective for mild ischemic stroke patients with or without disability.