Efficacy And Safety Of Rt-PA Intravenous Thrombolysis Treatment In Patients With Wake-up Strokes Under The Guidance Of Multimode MR

Objective To investigate efficacy and safety of rt-PA intravenous thrombolysis treatment in patients with wake-up strokes(WUS).Methods 1.We reviewed the 400 patients with acute ischemic stroke in Tianjin Huanhu Hospital from June 2014 to October 2016,which were divided into wake-up strokes treated with thrombolysis group;wake-up strokes non-treated with thrombolysis group;and clear-onset time treated with thrombolysis group.The onset time of the patients was 3 hours in the clear-onset time treated with thrombolysis group.The onset time was within 3 hours in the wake-up strokes.2.All patients' basic datas,the NIHSS score of 24 h and 7days after treatment,the mRS score of 90 days after treatment,the mortality and the incidence of cerebral hemorrhage were recorded.3.Prognosis and safety evaluation:(1)Evaluation of short-term prognosis: after treatment of 24 h and 7days,the NIHSS score decreased more than 4 points or neurological symptoms disappeared completely,called the recent good prognosis,otherwise,the prognosis is poor in the near future.(2)Long term prognosis evaluation: the mRS score after 90 days treatment of patients with 0-2 was divided into a good long term prognosis,otherwise,the prognosis was divided into a poor long-term prognosis.(3)Safety evaluation: safety is mainly evaluated by the incidence of intracranial hemorrhage and stroke related mortality after thrombolysis.Results 1.Compared with the patients in three groups,there was no significant difference in the age,gender,risk factors,the baseline NIHSS score and laboratory test results(P>0.05).2.There were 82 patients(64.1%)with good prognosis after 24 h and 106 patients(82.8%)with good prognosis after 7days in WUS thrombolysis group;however there was only about 45 patients(38.8%)with good prognosis after 24 h and 73 patients(62.9%)with good prognosis after 7days in WUS non-thrombolysis group,there was significant difference between the two groups(P<0.05).3.At 3 months,the patients with good prognosis in WUS thrombolysis group was better than WUS non-thrombolysis group(P<0.05).4.Between the WUS thrombolysis group and WUS non-thrombolysis group there were no symptomatic intracranial hemorrhage;non symptomatic intracranial hemorrhage rate were 1.6% and 0.9%;the mortality rate were 0% and 0.9%,there were no significant differences(P>0.05).5.There were 82 patients(64.1%)with good prognosis after 24 h and 106 patients(82.8%)with good prognosis after 7days in WUS thrombolysis group;however there was only about 102 patients(65.4%)with good prognosis after 24 h and 132 patients(84.6%)with good prognosis after 7days in clear-onset time group,there was no significant difference between the two groups(P>0.05).6.At 3 months,the patients with good prognosis was no difference between the two groups(P>0.05).7.When the WUS thrombolysis group and clear-onset time group were compared,symptomatic intracranial hemorrhage rate were 0% and 0.6%;non symptomatic intracranial hemorrhage rate were 1.6% and 1.3%;the mortality rate were 0% and 0.6%,there were no significant differences(P>0.05).Conclusion 1.The short-term effects and long-term prognosis in WUS thrombolysis group were significantly better than the patients in WUS non-thrombolysis group.2.There was no significant difference in the incidence of symptomatic intracranial hemorrhage,the incidence of no-symptomatic intracranial hemorrhage and the mortality between the WUS thrombolysis group and WUS non-thrombolysis group.3.There was no significant difference in the near future prognostic evaluation,the Long term prognosis evaluation,the risk of hemorrhagic transformation and the stroke related mortality between the WUS thrombolysis group and the clear-onset time thrombolysis group.