Analysis Of The Safety And Prognosis Of Intravenous Thrombolysis In Patients With Wake Up Stroke By Magnetic Resonance Imaging

Objectives To Analysis the safety and prognosis of intravenous thrombolytic therapy in patients with wake up stroke by magnetic resonance imaging(MRI).Methods.Collected two hundred and seventy-three patients with ischemic stroke in North China university of science and technology affiliated hospital admitted from September 2013 to December 2015,which were divided into wake up group and clearonset time stroke group according to whether know the onset time of their disease.According to whether received thrombolytic therapy, the wake-up group was divided into thrombolysed wake up group and nonthrombolysed wake up group.The baseline data of two groups were collected to compare the difference between the two groups. The two groups of patients were excluded intracranial hemorrhage by 16 layers of brain CT examination.The wake up group needed to additional DWI and FLAIR examination on the basis of in line with the pre-set conditions. If the DWI and FLAIR imaging is mismatch,the same given rt-PA treatment. If the DWI and FLAIR imaging is match, given conventional treatment of stroke. The safety of thrombolytic therapy was evaluated by Cerebral hemorrhage after thrombolysis, and the prognosis was evaluated by m RS score and mortality rate after 90 days.Results There was no significant difference in gender, age, the NIHSS score,cerebrovascular disease risk factors and TOAST classification between the thrombolysed wake up group and clear-onset time stroke group(P>0.05). Thrombolysed wake up group and clear-onset stroke group incidence rate of intracranial hemorrhage after thrombolytic therapy was 1.9% and 2.1% respectively.Thrombolysed wake up group asymptomatic intracranial hemorrhage rate was 1.9%(1/54), no symptomatic intracranial hemorrhage,clear-onset stroke group asymptomatic intracranial hemorrhage was 0.7%(1/145), symptomatic intracranial hemorrhage rate was 1.4%(2/145), the difference were not significant difference(P>0.05). No intracranial hemorrhage occurred in the nonthrombolysed wake up group. After thrombolysis treatment, the NIHSS score of wake up group were significantly lower than addision.,compared with clear-onset stroke group,there was no significant difference in the NIHHS scores of each time point after thrombolysis(P>0.05).After treatment, the NIHSS score of the nonthrombolysis wake up group was lower than that of the thrombolysed wake up group at the same time, the difference was significant(P<0.05). The thrombolysed wake up group and clear-onset stroke group 90 day m RS score 0-1 incidence rate were 35.2% versus 37.9%(P =0.722),90 day m RS score 0-2 incidence rates were 53.7% versus 62.1%(P = 0.285), the incidence of 90 day mortality rate was 1.9% versus 1.4%,respectively, the difference was not significant difference(P>0.05).Wake up stroke patients after thrombolysis treatment 90 days m RS scores 0-1, 90 days m RS scores 0-2 were significantly higher than wake up stroke patients without thrombolysis treatment(respectively 12.5%、29.2%),the difference was significant(P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusions Intravenous thrombolytic therapy under the guidance of the DWI-FLAIR is safe and effective,does not increase the risk of cerebral hemorrhage and prognosis of patients can be improved; to screen the wake up stroke by DWI-FLAIR mismatch, there are still some patients can benefit from thrombolytic therapy.