Predictive Value Of Vascular Ultrasound On Effect Of Intravenous Thrombolytic Therapy In Patients With Ischemic Stroke

BackgroundWith the great changes of production and life style brought by the development of science and technology,ischemic stroke has become a great threat to people’s health because of its high incidence,high disability and fatality.Intravenous thrombolysis and endovascular interventional treatment can effectively improve the prognosis of patients.Intravenous thrombolytic therapy in the time window is especially safe and simple,which has become the first-line treatment method.However,there are some problems in intravenous thrombolysis,such as the increasing incidence of post-treatment hemorrhage transformation,the difference of curative effect among different patients,etc.Previous studies have shown that thrombolytic therapy based on imaging findings may be more logical.Magnetic resonance and vascular ultrasound have no radiation injury,non-invasive and easy to operate.They can not only obtain the information of vascular structure,but also obtainthe information of hemodynamic.So I chose this research direction.ObjectivesTo observe the clinical changesandthe imaging features of vascular ultrasound in acute ischemic stroke patients receivied intravenous thrombolysis.To analyze the correlation between blood flow grading of middle cerebral artery,vesselocclusion location,blood supply of pial collaterals,right-left shunt,severe carotid stenosis or occlusion,establishment of collateral circulation,ulcerative atheroscleroticplaquesand the efficacy of intravenous thrombolytic therapy in patients with middle cerebral artery occlusion stroke.To investigate whether these imaging features have predictive significance for the efficacy of intravenous thrombolytic therapy.MethodsAll acute ischemic stroke patients who received intravenous thrombolysis in the green channel of stroke from June 2017 to March 2018 were given the TCD examination,a total of107 patients with middle cerebral artery occlusion were elected for group.All the basic information of the patients,blood pressure,blood glucose and other clinical data within72 hoursof receiving intravenous thrombolysis were recorded.All patients were given the standard intravenous thrombolysis according to the clinical guidelines and contrast TCD examination(c-TCD),cervical ultrasound,magnetic resonance angiography,the second TCD within 24 hours,we observed andrecorded blood flowgrading,vesselocclusion location,blood supply of pial collaterals,severe carotid stenosis or occlusion,right-left shunt,establishment of collateral circulation and ulcerative atherosclerotic plaques.The consistency of MRA and TCD after intravenous thrombolysis was analyzed,and the factors related to "significant improvement" after intravenousthrombolysis were discussed."Significant improvement" is defined as a NIHSS score reduction ≥ 10 points from the baseline,or a 0 or 1 post-treatment NIHSS score.Single factor and multivariate logistic regression analysis were performed to determine the predictive value for the efficacy of intravenous thrombolytic therapy.ResultsIn 107 patients,blood flow in the middle cerebral arteryimproved after intravenous thrombolysis in 84 patients(78.5 %).TCD and MRA after intravenous thrombolysiswere consistent in the diagnosis of middle cerebral artery blood flow grading.There were no significant differences in age,diastolic blood pressure,systolic blood pressure,blood sugar,NIHSS baseline score,time window,sex,hyperlipidemia,hypertension,diabetes,past medical history,smoking history,severe stenosis or occlusion of internal carotid,blood flow grading,vessel occlusion locationand blood supply of pial collaterals between the two groups(P>0.05).There were significant differences in ulcerative plaques,right-left shunt,atrial fibrillation and collateral circulation(P<0.05).In multivariate logistic regression analysis,right-left shunt and collateral circulation were independent predictors of significant improvement after intravenous thrombolysis(P<0.05).ConclusionsTCD is highly accurate in the diagnosis of middle cerebral artery occlusion and subsequent transmission.Right-left shunt and the establishment of collateral circulation are the independent predictors of the significant improvement after intravenous thrombolysis.CDU,TCD and c-TCD can provide valuable imaging and hemodynamic information.CDU,TCD and c-TCD can be used as an aid in the choice of individualized treatment options for acute ischemic stroke and help to predict the clinical effect and prognosis ofintravenous thrombolysis with rt-PAin patients with ischemic stroke.