| Objective:To evaluate the efficacy and safety of intravenous thrombolytic for treating acute ischemic stroke beyond the optimal time-window under the guidance of Multi-mode MRI,and to investigate the proper time of intravenous thrombolytic therapy for acute ischemic stroke.Moreover,the predictors of outcome will be analyzed,which will provide a guide for clinical work.Methods:433 patients with acute ischemic stroke from this stroke center were retrospectively collected,and these patients were treated by intravenous thrombolysis with standard dose of recombinant plasminogen activator(rt-PA)under the guidance of Multi-mode MRI.286 patients in whom thrombolytic treatment was initiated within 4.5 hours after symptom onset,defined as standard window group(≤4.5 h);147 patients in whom thrombolytic treatment was initiated from 4.5 hours to 12 hours after symptom onset,defined as beyond the optimal time-window group(4.5 h-12 h).Neurological deficit score(NIHSS score),90-day mRS score,hemorrhage conversion rate and mortality were observed for the two group patients before and after intravenous thrombolysis,and then univariate and multivariate unconditional logistic regression models were used to analyze the prognostic factors of the population and two groups of patients.Results:For the population of 433 cases,there was no statistical significant difference of baseline data(age,sex,blood pressure,blood glucose,blood lipid and NIHSS score before thrombolysis)between the two groups.The median NIHSS score before thrombolysis of the two group was 7,and there was no statistical significant difference.The NIHSS scores of the two group were 4.0 and 2.0 after 3 days and 7 days of thrombolysis,respectively.All of these were significantly improved compared with that before thrombolytic therapy,but there were no statistical significant difference between the two groups.The proportion of the good prognosis rate(0-1 mRS),and the bad prognosis rate(3-6 mRS)after 90 days of intravenous thrombolysis for the standard window group(≤4.5h)and the optimal time-window group(4.5 h-12 h)were 78.7%versus 76.9%,and 8.7%versus 8.8%,respectively.All of these for the group were not statistically significant.For the population of 433 patients,there were 25 cases of intracranial hemorrhage,and the hemorrhage rate was 5.8%;there were 4 cases of death,and the death rate was 0.9%.In the standard window group(<4.5h),there were 14 cases of intracranial hemorrhage,and the hemorrhage rate was 4.9%.There were 2 cases of death,and the death rate was 0.7%.In the beyond the optimal time-window group(4.5 h-12 h),there were 11 cases of intracranial hemorrhage,and the hemorrhage rate was 7.5%.There were 2 cases of death,and the death rate was 1.4%.No statistical significant difference were observed between the two groups of the hemorrhage rate and the death rate.Predictors of favorable outcomes(mRS score 0-1)for the population were as follow:The single factor analysis showed that the history of hypertension(OR=0.49,95%CI 0.29-0.83),the pre-thrombolytic systolic blood pressure(OR=0.93,95%CI 0.88-0.98),the fasting blood glucose(OR=0.85,95%CI 0.78-0.93),the total cholesterol(OR=0.68,95%CI 0.55-0.83),the low density lipoprotein(LDL),the cholesterol value(OR=0.76,95%CI 0.60-0.96),and NIHSS score before thrombolysis(OR=0.79,95%CI 0.75-0.84)were significantly improved compared with that after thrombolytic therapy.The multivariate regression analysis indicated that the history of diabetes mellitus(OR=2.86,95%CI 1.15-7.12),the fasting blood glucose value(OR=0.83,95%CI 0.74-0.93),the total cholesterol value(OR=0.61,95%CI 0.40-0.94),and the NIHSS score before thrombolysis(OR=0.79,95%CI 0.74-0.84)were significantly improved compared with those after thrombolytic therapy.Predictors of favorable outcomes(mRS score 0-1)for the standard window(≤4.5 h)were as follow:The single factor analysis showed that the history of hypertension(OR=0.45,95%CI 0.23-0.87),the pre-thrombolytic systolic blood pressure(OR=0.93,95%CI 0.87-0.99),the fasting blood glucose(OR=0.86,95%CI 0.77-0.97),the total cholesterol(OR=0.66,95%CI 0.52-0.85),the low density lipoprotein cholesterol(OR=0.73,95%CI 0.55-0.99)before thrombolysis,and the NIHSS scores before thrombolysis(OR=0.80,95%CI 0.75-0.86)were significantly improved compared with that after thrombolytic therapy.The multivariate regression analysis indicated that the fasting blood glucose before thrombolysis(OR=0.81,95%CI 0.70-0.95),and the NIHSS score before thrombolysis(OR=0.79,95%CI 0.73-0.85)were significantly improved compared with those after thrombolytic therapy.Predictors of favorable outcomes(mRS score 0-1)for the beyond the optimal time-window(4.5 h-12 h)were as follow:The single factor analysis showed that the fasting blood glucose(OR=0.84,95%CI 0.73-0.97)and the pre-thrombolytic NIHSS score(OR=0.76,95%CI 0.68-0.86)were significantly improved compared with those after thrombolytic therapy.The multivariate regression analysis indicated that the NIHSS score before thrombolysis(OR=0.78,95%CI 0.68-0.88)was significantly improved compared with that after thrombolytic therapy.Statistical significant difference of the NIHSS score before thrombolysis was observed both by using the single factor analysis and the multivariate regression analysis.Conclusions:(1)Our single center retrospective case-control study shows that Intravenous thrombolytic with standard dose for treating acute ischemic stroke beyond the optimal time-window(hrombolytic treatment was initiated within 12 hours after symptom onset)under the guidance of Multi-mode MRI is effective and safe,which could make the patients with ischemic stroke beyond the optimal time-window receive more effective treatment.(2)The history of hypertension,the pre-thrombolytic systolic blood pressure,the fasting blood glucose,the total cholesterol,and the low-density lipoprotein cholesterol could direct the prognosis of intravenous thrombolytic therapy,and the fasting blood glucose and the NIHSS score were more relevant to the clinical prognosis.(3)The efficacy and safety of intravenous thrombolysis for patients beyond the optimal time-window need to be further validated by a large population-based prospective,multicenter randomized controlled trials. |
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