Evaluation Of Efficacy And Safety Of Intravenous Thrombolysis For Minor Ischaemic Stroke Based On CTA

ObjectiveThe purpose of this study was to investigate the efficacy and safety of intravenous thrombolytic therapy for mild stroke and the impact of factors such as intracranial and extracranial vascular stenosis and collateral circulation based on head and neck CTA on the clinical efficacy of intravenous thrombolytic therapy,in order to provide some reference for the treatment of mild stroke in the future and the determination of the optimal benefit group for thrombolytic therapy.MethodA total of 169 patients with Minor ischemic stroke(MIS)admitted to our hospital from September 2018 to October 2020 were collected.MIS was defined as National Institutes of Health Stroke Scale(NIHSS)≤5score.According to whether or not Recombinant tissue Plasminogen Activator(rt-PA)was used in Intravenous thrombolysis(IVT)treatment,thrombolysis group(IT)and non-thrombolysis group(N-IT)were divided into IT group(N = 73)and N-IT group(N = 96).Collecting the general information of the patients,assessing their Collateral circulation(CS)and Cerebral artery stenosis(CAS)according to the head and neck CTA,than Evaluating the prognosis by the modified Rankin Scale score at 90 d after treatment,and analyzing the influencing factors of prognosis by Multivariable logistic regression.Propensity score matching(PSM)was used to correct the disequilibrium of general data between the IT group and the N-IT group.Comparing the NIHSS score between before and 24 hours and 7 days separately to determine the efficacy,and observering the rate of symptomatic intracranial hemorrhage(s ICH)and other bleeding events without effect on neurological function to compare the safety.Results1.All 169 MIS patients were enrolled,including 73 in the IT group and 96 in the N-IT group.Univariate analysis of the outcomes of all MIS patients showed statistically significant differences between the good group and the poor group in the time from onset to treatment,NIHSS score before treatment,hypertension,history of stroke,collateral circulation,severe cerebral artery stenosis or occlusion,and thrombolytic therapy.Multivariate analysis showed thrombolytic therapy(OR:5.444,95%CI:2.112-14.034,P<0.001),good CS(OR:2.670,95%CI: 1.173-6.078,P=0.019),and lower NIHSS score before treatment(OR:1.856,95%CI:1.340-2.570,P<0.001)were independent influencing factors for good prognosis,and the presence of severe cerebral vascular stenosis/occlusion(OR:0.241,95%CI:0.105-0.555,P=0.001)was an independent influencing factor for poor prognosis.2.Before PSM,there were statistical differences in age,NIHSS score before treatment and stroke history between the two groups.A total of 84 patients were included after PSM,including 42 patients in the IT group and 42 patients in the N-IT group,and their general data had no statistical difference(P > 0.05).3.Before PSM,the rate of good prognosis in IT group and N-IT group without severe cerebral vascular stenosis/occlusion was higher than that in the poor group,with statistical significance(P < 0.05).In the IT group,patients with good CS had a higher rate of good prognosis than those with poor CS,and the difference was statistically significant(P=0.036).In the N-IT group,patients with good CS also had a higher rate of good prognosis than those with poor CS,but the difference was not statistically significant(P > 0.05).4.After PSM,the difference of NIHSS scores between the IT group and the N-IT group before treatment and 24 h and 7d after treatment was statistically significant,and the proportion of good prognosis at 90 days in the IT group was higher than that in the N-IT group.s ICH didn’t show in the two groups.5.After PSM,for MIS patients with severe cerebrovascular stenosis/occlusion,the proportion of good prognosis in IT group was higher than that in N-IT group,and the difference was statistically significant.In MIS patients without severe cerebrovascular stenosis/occlusion,the proportion of good prognosis in the IT group was also higher than that in the N-IT group,but the difference was not statistically significant.For MIS patients with good or bad CS,the rate of good prognosis in the IT group was higher than that in the N-IT group,and the difference was statistically significant.Conclusions1.Intravenous thrombolytic therapy is safe and effective treatment for MIS.2.MIS with severe cerebrovascular stenosis or occlusion may benefit from intravenous thrombolytic therapy.3.Good collateral circulation(r LMC srore≥15 points)is beneficial to the prognosis of intravenous thrombolytic therapy for MIS.4.For patients with MIS,thrombolytic therapy,lower NIHSS score before treatment and good collateral circulation(r LMC srore≥15 points)were independent influencing factors for good prognosis,while severe cerebrovascular stenosis was independent influencing factors for poor prognosis.