Efficacy And Safety Analysis Of Intravenous Thrombolysis In Patients With Mild Ischemic Stroke

Objective:1.To analysis the efficacy and safety of intravenous thrombolysis(IVT)with recombinant tissue plasminogen activator(rt-PA)in patients with mild ischemic stroke(MIS).2.To predict the prognosis of MIS patients receiving intravenous rt-PA therapy by multimodal CT.Methods:The clinical data of patients who diagnosed MIS in stroke center of the First Affiliated Hospital of Nanchang University from October 2018 to February 2020 were analyzed retrospectively.The diagnosis standard of MIS:clinical symptoms,signs and imaging meets the diagnostic criteria of "China Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018",and the NIHSS score was?5 points at admission,the consciousness score is 0,and the mRS score was?3points,189 patients were included.The patients were divided into IVT group(treated with rt-PA)and non IVT group(treated with aspirin,clopidogrel alone or in combination)according to whether thrombolytic therapy was used.National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological deficit at 24 hours and 7 days after treatment,and patients were followed up by modified Rankin Scale(mRS)score(0-1 points for good prognosis,2-6 points for poor prognosis)for quality of life at 90 days after treatment.The NIHSS score,mRS score,incidence of symptomatic intracerebral hemorrhage(sICH)and early neurological deterioration(END)were observed in IVT group and non IVT group.At the same time,patients were divided into two groups,according to the imaging examination whether there were offending vessels or ischemic penumbra(IP).There were 119 patients in the artery atenosis group(52 in the IVT group,67 in the non IVT group);55 patients in the IP group(28 in the IVT group,27 in the non IVT group),the efficacy and safety of IVT in patients with artery atenosis or IP were analyzed by stratification.Results:(1)Efficacy of IVT treatment:The NIHSS score of IVT group was lower than that of non IVT group at 24 hours and 7 days after treatment(P <0.05).The rate of good prognosis in IVT group was higher than that in non IVT group at 90 days after treatment(P= 0.009).(2)Safety of IVT treatment: There was no statistically difference in the incidence of END between IVT group and non IVT group(P > 0.05).sICH did not occur in both groups.(3)In the presence of artery atenosis: The NIHSS score in the IVT group was lower than that in the non IVT group at 24 hours and 7 days after treatment(P<0.05).The rate of good prognosis in IVT group was higher than that in non IVT group at 90 days after treatment(P=0.004).There was no statistically difference in the incidence of END between the two groups(P>0.05).sICH did not occur in both groups.(4)In the presence of IP:There were no statistically differences in the NIHSS score at 24 hours and 7 days after treatment,the rate of good prognosis at 90 days,and the incidence of END between the IVT group and the non IVT group(P >0.05).sICH did not occur in both groups.Conclusions:(1)The rt-PA treatment can effectively improve the neurological function and prognosis of patients with MIS,and does not increase the incidence of adverse events.(2)The rt-PA treatment can improve neurological deficit and prognosis in MIS patients who's computed tomography angiography(CTA)shows the presence of artery atenosis,and does not increase the risk of sICH and END.(3)Early treatment of rt-PA may decrease the occurrence of large-area infarction and severe neurological deficits in MIS patients who's computed tomography perfusion(CTP)shows the presence of IP.