Clinical Prognostic Analysis Of Intravenous Thrombolysis For Acute Brain Infarction

Part ITheEfficacy and Outcome Predictors of Intravenous Thrombolytic Therapy for Acute BrainInfarctionBackground and Purpose:Acute brain infarction is a common ischemic cerebrovascular disease with high mortality and morbidity. The efficacy of intravenous thrombolytic therapy for acute cerebral infarction has been confirmed by a serious of clinical trials. The purpose of this study was to determine factors associated with clinical improvement in patients with acute ischemic stroke treated with intravenous thrombolysis.Methods:Patients treated with intravenous recombinant tissue plasminogen activator (rtPA) between January2008and December2012were the subjects of this study. Favorable outcome was defined as modified Rankin scale (mRS)≤2at3months. The baseline characteristics were compared between patients with and without outcome of interest.Results:Of the113patients studied53(46.9%) patients had clinical improvement (86%) had favorable outcome at three months. The median age was69year-old (interquartile range [IQR]:56-74). Male percentage was65.5%. The baseline median National Institutes of Health Stroke Scale (NIHSS) score was10(IQR6-14). Multivariate analysis revealed that basement NIHSS (odds ratio (OR)1.128, P=0.005),24h NIHS (OR1.230, P<0.001) and history of previous stroke or TIA (OR3.993, P=0.044) were inversely associated with favorable outcome. Conclusions:The effect of intravenous thrombolysis is time-dependent. Baseline NIHSS,24-hour NIHSS and history of previous stroke or TIA are independent predictorsoffavorable outcome. Part Ⅱ Optimization of EmergencyProcedures to ImprovetheEfficacyofintravenous Thrombolytic TherapyofAcute Brain InfarctionBackground and Purpose:Efficacy of thrombolytic therapy for ischemic stroke decreases with time elapsed from symptom onset. Wehopethatthrough ouroptimizedemergency thrombolyticprocedurescouldreduce in-hospitaldelays.Methods:A series of interventions to reduce treatment delays were implemented sinceJuly2011. In-hospital delays were analyzed as annual median DNT in minutes and the rate of DNT<60minutes.Results:A total of2,564patients with cerebral infarction were admitted between January2008and December2012,115patients received intravenous thrombolytic therapy. The median age was69year-old (interquartile range [IQR]:58-79). Male percentage was64.0%. The baseline median National Institutes of Health Stroke Scale (NIHSS) score was10(IQR6-14). Percentage of thrombolytic use was increased from1.9%to8.9%(p<0.001). Median DNT was reduced from100minutes (IQR86-112) to73minutes (IQR55-96)(p<0.001). Rate of DNT<60minutes was increased from6.5%to33.8%(p=0.003). Conclusions:Achieving DNT<60minutes for the majority of thrombolytic therapy candidates is still our goal. Furthersimplifyingthethrombolyticprocedures to treat the patients faster will help us to achieve this goal inthefuture. Part Ⅲ Study on the Relationship between Multi-mode CT and the Clinical Prognosis in Acute BrainInfarctionObjective:The decision of acute recanalization treatments on patients with acute brain infarction now are based on time windows. We designed a study to assess feasibility of a trial of multi-mode CT in patients with ischemic tissue at risk of infarction. Hope that using multi-mode CT imaging in patients to find histological differences in individual tissue could guide thrombolytic therapy in the future.Methods:We respectively studied consecutive patients with hemisphericischemia presenting within12h of symptom onset. All patients underwentbaseline multimodal CT examination (NCCT, cerebral CTP and CTA) and follow-up cerebral MRI+DWIand CTP at24h. Clinical stroke severity using the National Institution of Health Stroke Scale (NIHSS) was performed immediately prior toimaging, and level of disability at3months was measured with themodified Rankin scale.Patients were divided into groups by state of large vessel occlusion, thrombolytic therapy, targetmismatch and reperfusion condition. The difference between the groups at baseline and clinical outcome were compared.Results:From December2011to December2012, a total of71patient were enrolled, with a median age of63years old(interquartile range [IQR]:58-79),66%male percentage, and the median baseline NIHSS5. The median onset to multi-mode CT timewas262seconds.Favorable3months clinical outcomes inthe patients without baseline vascular stenosis or occlusion were more than that with vascular occlusion (P=0.007). Among the patients with target mismatch, patients with early reperfusion had both better early clinical improvement and better3monthsclinical outcomes compared with patients without reperfusion (P=0.026and P=0.042). Thrombolytic therapy can increase the proportion of reperfusion by25%, but the result was no significant difference (P=0.234).Conclusion:Multi-mode CT can show acute cerebral infarction and cerebrovascular hemodynamic information in patients with acute brain infarction.Patients with stenosis or occlusion of large vessels and target mismatch should be given thrombolytic therapy. And early reperfusioncan improve patients’ clinical outcomes.