Clinical Prognostic Analysis Of Multi-mode MRI Guiding Intravenous Thrombolytic Therapy In Patients With Acute Ischemic Stroke

Objective:To evaluate the safety and efficacy of multimodal magnetic resonance imaging in guiding intravenous thrombolysis in patients with wake-up stroke,in order to further guide individualized thrombolytic therapy..Methods:Acute ischemic stroke patients were collected from January 2018～December 2020.The following conditions were met:1.cerebral hemorrhage was excluded after head CT examination and met the diagnostic criteria of cerebral infarction as stipulated in the^[1]of Chinese guidelines for the diagnosis and treatment of acute ischemic stroke 2018;2.A multi-mode MRI imaging examination was performed before treatment;3:Informed consent was signed before intravenous thrombolytic therapy.According to the onset time of the patient,it was divided into the post-awake stroke group and the onset time<4.5 hours stroke group.Both groups underwent multiple MRI tests before treatment,Matching according to diffusion-weighted imaging（DWI）and fluid attenuation inversion recovery sequence（FLAIR）,The groups were further divided into DWI/FLAIR mismatched subgroups and DWI/FLAIR matched subgroups.Patients with stroke group with<onset time of 4.5 hours who metlytic standard were treated with rt-PA intravenous thrombolytic therapy.DWI/FLAIR mismatched wake-up stroke group,rt-PA intravenous thrombolytic therapy agreed by the patient or family member,Routine antiplatelet therapy for intravenous thrombolysis without consent.The NIHSS scores of 7 d before and 24 d after treatment were recorded in all patients,The clinical curative effect and prognosis were evaluated by modified mRS score in 90d,To evaluate the safety of intracranial hemorrhage and symptomatic intracerebral hemorrhage after thrombolysis.Results:The NIHSS scores and improved mRS scores of 24 h and 7 d in the stroke group with4.5 h after intravenous thrombolysis were better than those in the DWI/FLAIR matching group（P<0.05）.The proportion of intracranial hemorrhage in DWI/FLAIR matching group was higher,the difference between the two groups was statistically significant（P<0.05）.（2）The onset time of DWI/FLAIR mismatch patients<4.5 h the NIHSS score and mRS score of 24 and 7 d after thrombolysis were not significantly different between stroke group and wake-up stroke group（P>0.05）,and there was no difference in bleeding risk（P>0.05）.（3）The NIHSS scores and 90 dmRS of 24 h and 7 d after intravenous thrombolysis in the wake-up stroke group were significantly better than those in the conventional antiplatelet aggregation therapy group（P<0.05）,and there was no significant difference in bleeding risk（P>0.05）.Conclusion:1、The DWI/FLAIR mismatch in multimodal MRI suggests that there is still a salvageable ischemic penumbra in the brain tissue of the patient.Under the guidance of multimodal MRI,the stroke patients can benefit from intravenous thrombolysis and provide an effective and safe choice for the prolongation of the time window of intravenous thrombolytic therapy.2、Patients with acute ischemic stroke with onset time less than 4.5 hours,DWI-FLAIR mismatched patients were more effective and safe after thrombolysis than DWI-FLAIR matched patients.