The Early Outcomes Correlated Factors Of Acute Ischemic Stroke Patients With Thrombolysis

Objects:To identify variable associated with symptomatic intracerebral hemorrhage(sICH) and early outcomes in patients with acute ischemic stroke who receiverecombinant tissue plasminogen activator (rt-PA).Methods:As a retrospectively case control study， all patients hospitalized receivedthrombolytic therapy (intravenous or intra-arterial or combination) were selected fromDepartment of Neurology，the Fist Affiliated Hospital of Jinan University fromJanuary1994to December2011. According to the medical records, collected clinicaldata of all patients, including baseline neurological deficit score (assessed by theNational Institute of Health stroke scale，NIHSS), onset to start of treatmenttime(OTT), modified Rankin scale (mRs) and Glasgow outcome scale (GOS)and soon. All patients were classified into subtypes according to OCSP classification. Thestudy was performed separately according to the basilar artery occlusion or not. Theearly poor outcome of the former was defined as1～2of GOS (death or vegetativestate) at discharge. The latter was defined as5～6of mRS. And statistical analysiswas performed with SPSS for Windows, version13.0. The measurement dates wereexpressed as mean±standard deviation (SD) or median (inter-quartile range). Andthey were compared using t test or the Wilcoxon W test. The enumeration dates wereexpressed as number (percentage). And they were compared using χ2test or fisher’sexact test. The Logistic regression was used to analyse the related factors of earlyoutcome in acute ischemic stroke patients with thrombolysis.Results:A total of84consecutive patients (68of intravenous thrombolysis,15ofintra-arterial thrombolysis and1of combination) were evaluated. Mean age was64.8±10.8years (rang21to84years). The men were56(66.7%). The baseline NIHSS score of the series on admission was13(rang3～38). The median of thesymptom onset to start of treatment (OTT) was3.48hours (rang1～504hours). Forthe patients received the intra-arterial thrombolytic therapy, OTT was9hours (1-504hours). The median of mRS was2(0～6) at discharge. According to the classification,the TACI were38patients, PACI were28patients, POCI were16patients and LACIwere2patients. Clinical assessment revealed that sICH occurred in9(10.7%) patientsand14(16.7%) patients with early poor outcome (6of acute basilar artery occlusionand8of non-basilar artery occlusion). Early poor outcome was associatedsignificantly with a higher baseline NIHSS score. The age and baseline systolic bloodpressure of early poor outcome patients were significantly higher than other patientsin acute basilar artery occlusion (P＜0.05). For the non-basilar artery occlusionpatients, univariate analysis revealed that early poor outcome patients were all TACI(100%，P=0.042), and the percentage of the coronary heart disease (62.5%Vs21.3%，P=0.039) and the baseline NIHSS (17Vs11，P=0.002) were significantly higher thanothers. And the baseline NIHSS was keeping on significant difference between earlypoor outcome patients and not in the Logistic regression.Conclusions:The baseline NIHSS may be a predictor of the prognosis for the patients withthrombolytic therapy, especially for intravenous thrombolysis. And the aggressivetherapy should be made for the acute basilar artery occlusion (BAO) patients. Theratio of benefit risk would be obviously either intravenous or intra-arterialthrombolytic therapy. The sICH, older age, higher baseline blood pressure and NIHSS,as well as longer OTT may associated with early poor outcome.