Study On The Safety And Efficacy Of Intravenous Thrombolysis In Patients With Acute Ischemic Stroke Complicated With Ischemic White Matter Lesions

Objective Study intravenous thrombolysis in patients of the efficacy and safety complicated with ischemic white matter lesions.METHODS:1.Collect 199 cases of ischemic WML of Tian Jin Huanhu Hospital during October2019 to July 2018,the AIS patients within 4.5h,including thrombolysis group,99 cases of patients,non thrombolysis group,100 cases of patients,intravenous thrombolysis therapy,and the same conditions of 50 cases of patients with ischemic cerebral white matter lesions of AIS,were retrospectively analyzed.The patients were divided into :(1)99 cases of ischemic WML thrombolysis group;(2)100 patients in the ischemic WML non-thrombolytic group.The Fazekas score(0-6 points)was defined as moderate to severe white matter lesion group under the condition of ventricular voiceover mass lesion score(3 points)and/or deep white matter lesion score(2-3 points).The group was defined as mild WML with ventricular voiceover mass lesion score of 1-2 and/or deep white matter lesion score of 1.The venous thrombolysis group was divided according to the Fazekas score to assess the severity of ischemic WML :(1)50 patients in the non-ischemic WML thrombolysis group.(2)58 patients with mild ischemic WML thrombolytic group;(3)41 patients with moderate or severe ischemic WML thrombolytic group.2.Gender,age,vascular disease risk factors,test results(blood routine blood glucose hypersensitive CRP,etc.),NIHSS score at 1h,24 h,7d after intravenous thrombolysis at admission,and m RS score after 3 months of follow-up were recorded.3.Efficacy evaluation :(1)NIHSS score decreased by >4 points or neurological dysfunction defect completely disappeared 24 hours and 7 days after intravenous thrombolysis,indicating a good short-term prognosis;The decrease of NIHSS score <4 points defined a poor recent prognosis.(2)Three months after intravenous thrombolysis,the m RS score was 0 to 2 points,which defined a good long-term prognosis.3-month score of 3-6 defined a long-term poor prognosis.4.The incidence and mortality of intracranial hemorrhage transformation(including s ICH and asymptomatic intracranial hemorrhage)within 24 hours after thrombolysis were compared between the two groups.Results1.Comparison of improvement of nerve function defect between the treatment group with ischemic WML and the non-treatment group after treatment: 67 patients(67.7%)in the thrombolytic group and 54 patients(54.0%)in the non-thrombolytic group after24 hours.After 7d,72 patients(72.7%)in the thrombolytic group and 59 patients(59.0%)in the non-thrombolytic group.After 90 days,76 patients in the thrombolytic group(76.8%)and 64 patients in the non-thrombolytic group(64.0%)had statistically significant differences between the two groups(P<0.05).Comparison of dead patients:2 patients in the thrombolytic group(2.0%)and 1 patient in the non-thrombolytic group(1.0%);There was no significant difference in s ICH and mortality(P>0.05).2.Comparison of improvement of neurological impairment in patients without ischemic WML and those with mild WML after 24 h intravenous thrombolysis: 46(92.0%)patients in the non-wml group and 44(75.9%)patients in the mild group after 24 h.After 7 days,there were 47 cases(94.0%)in the WML group and 47 cases(81.0%)in the mild group.After 90 days,there were 48 cases(96.0%)in the non-wml group and 49 cases(84.5%)in the mild group.There was a statistical difference between the two groups(P<0.05).Comparison of patients with s-ICH: 0 in the non-WML group and 0 in the mild group;Comparison of dead patients: no WML group is 0,mild group is 1(1.7%);There was no significant difference in s ICH and mortality(P>0.05).3.Comparison of improvement of neurological impairment in patients with mild ischemic WML and moderate or severe WML after 24 h intravenous thrombolysis:44patients(75.9%)in the mild group and 23 patients(56.1%)in the moderate or severe group after 24 h.There were 47 cases(81.0%)in the mild group and 25 cases(61.0%)in the moderate and severe group after 7d.On the 90 d,there were 49 cases(84.5%)in the mild group and 27 cases(65.9%)in the moderate and severe groups.There were statistically significant differences between the two groups(P<0.05).The patients with s ICH were 0 in the mild group and 2 in the moderate and severe group(4.9%).Comparison of patients with death: 1(1.7%)in the mild group and 1(2.4%)in the moderate and severe group;There was no significant difference in s ICH and mortality(P>0.05).Conclusion1.Patients with acute ischemic stroke with ischemic WML had significantly better prognosis after intravenous thrombolysis than those without thrombolysis.Patients without ischemic WML had better prognosis than those with mild ischemic WML,and those with mild WML had better prognosis than those with moderate or severe WML.2.Compared with the non-thrombolytic group,patients with acute ischemic stroke with ischemic WML who received intravenous thrombolysis increased the risk of bleeding transformation,and patients with moderate to severe ischemic WML were more likely to have bleeding transformation than those with mild ischemic WML.However,they did not cause s ICH and other adverse reactions,nor did they increase the death rate of the patients,so intravenous thrombolytic therapy has a high safety.