Clinical Analysis Of Multi-modal MRI-guided Intravenous Thrombolysis In Patients With Acute Ischemic Stroke

Objective To investigate the effectiveness and security of multi-modal MRI-guided intravenous thrombolysis.Methods We retrospectively reviewed our continuously collected clinical, laboratory, and radiologic data of patients receiving intravenous rtPA therapy, who had both pretreatment and24h post-treatment multimodal MRI in our hospital. To compare the clinical outcome of our study with NINDS rtPA test. To compare baseline demographics and imaging features between different PWI-DWI patterns. Among24patients with vascular stenosis or occlusion, Recanalization and non-Recanalization were divided according to the vascular conditions. To compare imaging features between two groups.Results Among45patients analyzed,20(44%)patients got0-1point of mRS3months after stroke.3(7%) patients died. Symptomatic intracranial hemorrhage developed in2(4%) patients. Nineteen (41%) patients presented "Target mismatch", of which8patients were treated over4.5h. The rate of reperfusion and early neurological improvement after thrombolysis in Target mismatch group were both significantly increased compared with non-Target mismatch group,84%vs42%(P<0.05) and68%vs17%(P<0.05), respectively. The pooled OR for reperfusion was 6.4(95%CI:1.156-35.437; P=0.034), and the pooled OR for favorable clinical response was21.7(95%CI:2.234-210.11; P=0.008) in Target Mismatch patients.81%of patients with reperfusion had early neurological improvement, while no patients without reperfusion had neurological improvement. The rate of recanalization, reperfusion and neurological improvement after thrombolysis demonstrated no significant difference between Target mismatch group treated within4.5h and beyond4.5h. The rate of recanalization in patients with ICA stenosis or occlusion were smaller (29%vs70%, P<0.05). The patients with recanalization got smaller PWI volume (14±31vs103±85, P=0.001), higher rate of reperfusion (93%vs30%, P=0.001) and more early neurological improvement (64%vs20%, P<0.05). The DWI lesion expasion was larger in the non-Recanalization(85±103vs6±42, P=0.011). But the rate of hemorrhagic translation demonstrated no significant difference between two groups.Conclusion Patients with Target mismatch profile before thrombolysis had a high reperfusion rate and were prone to get early neurological improvement, which indicates that the evaluation of PWI-DWI mismatch may facilitate the selection of patients who may benefit from thrombolysis beyond the time window.