Efficacy And Safety Of Rt-PA Intravenous Thrombolytic Therapy For Mild Acute Ischemic Stroke

Objective: To investigate the efficacy and safety of rt-PA intravenous thrombolysis for mild acute ischemic stroke,and the risk factors for poor prognosis after 90 days of intravenous thrombolysis in patients with mild acute ischemic stroke were analyzed.Methods: 145 patients with acute ischemic stroke who received intravenous thrombolytic therapy with rt-PA in Changzhou NO.2 People’s Hospital from January2018 to December 2019 were retrospectively collected,including 67 patients with mild ischemic stroke(NIHSS≤5 points)and 78 patients with non-mild ischemic stroke(NIHSS>5 points).The differences in baseline data,thrombolytic improvement rate,early neurological deterioration rate,short-term outcome,complications,and mortality were compared between the two groups.In the univariate analysis,factors with P<0.05 were used as independent variables.Multivariate binary Logistic regression was used to analyze the risk factors for poor outcome in patients with mild stroke after 90 days of intravenous thrombolysis.Results: 1.Baseline data of mild ischemic stroke and non-mild ischemic stroke groups were compared,two groups have significant difference in age and the prevalence of atrial fibrillation,Patients in the mild stroke group were younger(P<0.001),lower prevalence of atrial fibrillation(P=0.004),in addition,in the laboratory examination,mild stroke group was higher triglyceride levels(P=0.001),and the low level of Ddimer(P=0.012),the difference between the two groups have statistical significance.2.The proportions of aortic atherosclerosis type and cardiogenic embolism type in the mild stroke group were lower than those in the non-mild stroke group(25.4% vs 57.7%,P<0.001;17.9% vs 37.2%,P=0.01),the proportion of small artery occlusion type in the mild stroke group was higher than that in the non-mild stroke group(52.2% vs 25.6%,P=0.001),and the difference was statistically significant.3.The NIHSS scores of the mild stroke group were lower than those of the non-mild stroke group on admission,after completion of thrombolysis,7d or discharge(less than7 d in hospital),and the difference was statistically significant.4.There was no significant difference in the rate of neurological improvement after thrombolysis between the mild stroke group and the non-mild stroke group,but the rate of neurological improvement at 7d or after discharge in the mild stroke group was significantly higher than that in the non-mild stroke group(77.6% vs 37.2%,P<0.001),and the difference was statistically significant.In addition,there was no significant difference in the proportion of END between the two groups.5.Patients with mild stroke had a better 90 d outcome(MRS <2)than those with nonmild stroke,and the difference was statistically significant(74.6% vs 29.5%,P<0.001).Patients with mild stroke had a higher 90 d complete recovery rate(MRS =0)than those with non-mild stroke(38.8% vs6.4%,P<0.001),and the difference was statistically significant.6.The proportion of stroke-related pneumonia and intracranial hemorrhage in the mild stroke group was lower than that in the non-mild stroke group(9% vs 30.8%,P=0.001;9% vs 30.8%,P=0.032),the difference was statistically significant,and there was no significant difference in SICH rate between the two groups.7.There was no significant difference in in-hospital mortality between the two groups.The 90-day mortality in the mild stroke group was significantly lower than that in the non-mild stroke group(1.5% vs 10.3%,P=0.038),and the difference between the two groups was statistically significant.8.Univariate Logistic regression analysis indicated that diabetes,atrial fibrillation,stroke-associated pneumonia and D-dimer were associated with poor 90 d outcome in patients with mild stroke.The factors of P<0.05 in univariate analysis were included in the multivariate Logistic regression model,and the analysis showed that atrial fibrillation and stroke-associated pneumonia were associated with poor outcomes at 90 d after intravenous thrombolysis in patients with mild stroke.Conclusion: 1.The differences between mild stroke patients and non-mild stroke patients were mainly manifested in younger age,lower prevalence of atrial fibrillation,higher triglyceride level,lower D-dimer level,higher proportion of small artery occlusion type,and lower proportion of large artery atherosclerosis type and cardiogenic embolism type.2.Intravenous thrombolytic therapy with rt-PA within 4.5h improved neurological function in patients with mild stroke,with a good short-term outcome and a lower risk of SICH and mortality.Atrial fibrillation and stroke-associated pneumonia were associated with poor 90-day outcome after intravenous rt-PA thrombolysis in patients with mild stroke.From what has been discussed above,Intravenous thrombolysis with rt-PA is effective and relatively safe in patients with mild ischemic stroke.