Clinical Analysis Of Intravenous Thrombolytic Therapy In Patients With Acute Cerebral Infarction By Different Etiologies

Objective: the main purpose of this study was to investigate the efficacy and safety of intravenous thrombolytic therapy with rt-PA in patients with acute cerebral infarction by different etiologic subtypes.Methods: the general data of patients with acute cerebral infarction receiving intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA)from the Second Affiliated Hospital of Nanchang University from October2016 to December 2017 were prospectively collected,including age,sex,past medical history(such as hypertension,diabetes,atrial fibrillation,coronary heart disease,smoking,drinking history,etc.),electrocardiogram,and craniocerebral magnetic resonance imaging(MRI),craniocerebral magnetic resonance angiography(MRA),neck to skull base CTA or head CTA,susceptibility weighted imaging(SWI),craniocerebral CT,the pretreatmem and 24 hours after thrombolysis National Institutes of Health Stroke Scale(NIHSS)score,time from symptom onset to therapy,the main complications of intravenous thrombolytic therapy(cerebral hemorrhage and cerebral hemorrhage types).According to the Chinese ischemic stroke subtype(CISS)standard,the acute cerebral infarction patients were divided into different etiologic subtypes.CISS classified stroke into five categories:large artery atherosclerosis(LAA),including atherosclerosis of aortic arch and intra-/extracranial large arteries,cardiogenic stroke,penetrating artery disease,other etiology,and undetermined etiology,and then further classified the underlying mechanism of ischemic stroke from the intracranial and extracranial LAA into the parent artery(plaque or thrombosis)occluding penetrating artery,artery-to-artery embolism,hypoperfusion/impaired emboli clearance,and multiple mechanisms.Result:62 cases of intravenous thrombolytic therapy with rt-PA in acute cerebral infarction were collected,included 14 male patients,and included 32 patients in subgroup of large artery atherosclerosis(LAA),21 patients in subgroup of cardiogenic stroke,5 patients in subgroup of penetrating artery disease,0 patients in subgroup of other etiology,4 patients in subgroup of undetermined etiology.Thepretreatmem NIHSS score was 13.9±6.4 minutes.There were 16 cases of cerebral hemorrhage after thrombolysis,including 12 patients with hemorrhagic infarction(HI)and 4 patients with parenchymal cerebral hemorrhage(PH).1.The efficacy of rt-PA thrombolysis in cerebral infarction with different etiologic subtypes:comparing with other etiologic subtype,there was no significant difference in the NIHSS score before thrombolysis in every etiologic subtype(P>0.05).The group of the parent artery(plaque or thrombosis)occluding penetrating artery which was one of mechanism of large artery atherosclerosis(LAA)and the group of penetrating artery disease showed a decreasing trend(11.2±5.8 vs 14.5±6.4,P=0.133 and 11.8±6.3 vs 14.2±6.4,P=0.429).The total effective rate of thrombolytic therapy in all patients was 62.9%.The total effective rate of thrombolytic therapy in every etiologic subtype was not less than 50%,and the total effective rate of thrombolytic therapy in various groups was not statistically significant(P>0.05).However,the total effective rate of thrombolysis in the group of the parent artery(plaque or thrombosis)occluding penetrating artery and the group of penetrating artery disease was higher than that of the other group(80% vs 59.6%,P=0.222 and80% vs 61.4%,P=0.409,respectively).2.The safety of rt-PA thrombolysis in cerebral infarction with different etiologic subtypes:there was no significant difference in the proportion of cerebral hemorrhage after thrombolytic therapy between each of 5 major etiologic subtypes and other group(P>0.05).But there was no intracerebral hemorrhage in patients of the group of the parent artery(plaque or thrombosis)occluding penetrating artery,and there was a statistically significant difference compared with other group(0% vs 30.8%,P=0.042).After thrombolysis,the proportion of cerebral hemorrhage in all patients was 25.8%,and each of all groups was less than 40%.Among them,the proportion of cerebral hemorrhage in subgroup of large artery atherosclerosis(LAA)had a declined trend(18.8% vs 33.3%,P=0.19).While the proportion of cerebral hemorrhage in subgroup of cardiogenic stroke a growing trend(33.9% vs 12.9%,P=0.114),and the majority of cerebral hemorrhage was parenchymal cerebral hemorrhage(PH).3.Single factor analysis of intracerebral hemorrhage after thrombolytic therapy:compared with the non-cerebral hemorrhage group,the pretreatmemt NIHSS score ofthe group with thrombolytic hemorrhage was significantly higher,and the statistical difference was significant(17.6±4.4 vs 12.7±6.5,P=0.006).In cerebral hemorrhage group,the age of patients was more older,the number of patients with diabetes and cardiogenic stroke was relatively increasing,but no statistical significance was found(P>0.05).Conclusion:1.The total effective rate of intravenous thrombolysis with rt-PA in each etiologic subtype of acute cerebral infarction was not significantly different comparing with other etiologic subtypes.2.The risk of cerebral hemorrhage after intravenous thrombolysis in the group of the parent artery(plaque or thrombosis)occluding penetrating artery which was one of mechanism of large artery atherosclerosis(LAA)was relatively low.3.The risk of intracerebral hemorrhage increased when the NIHSS score at admission was high.