| ObjectiveTo investigate the safety and efficacy of intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) in patients with cerebral infarct by different etiologic subtypes.MethodsWe retrospectively reviewed our prospectively collected clinical, laboratory, and radiologic data from75consecutive hyperacute ischemic patients who have received intravenous rtPA therapy in our hospital from June2009to April2011. Etiological subgroups were classified according to Chinese ischemic stroke subclassification (CISS). We compared the rate of hemorrhagic transformation (HT) and clinical outcome in different subgroups respectively. ResultsAmong75patients treated with intravenous rtPA, the mean age was67.4years,25(33.3%) were women, pretreatment National Institutes of Health Stroke Scale score (NIHSS) was12.3±6.4, and time from symptom onset to therapy was239.6±97.5minutes. Postlytic radiological HT was found in24patients (32%). Symptomatic intracranial hemorrhage occurred in4patients (5.3%). There were30patients (40%) in subgroup of large artery atherosclerosis (LAA),31patients (41.3%) in sbugroup of cardiogenic stroke,10patients (13.3%) in subgroup of penetrating artery disease, and4patients (5.3%) in other subgroups. There were22patients (29.3%) classified as isolated penetrating artery territory infarct (IPAI), only one of whom experienced HT. Logistic regression analysis suggested that IPAI was an independent predictor of reduced risk of HT. In the patients with IPAI,82%of them had an independent clinical outcome (mRS≤2) at one month after onset, and the neurological outcome were better in patients with IPAI than non-IPAI (P<0.01).ConclusionThe risk of hemorrhagic complication was uncommon and the clinical outcome was good in patients with isolated penetrating artery territory infarct after intravenous thrombolytic therapy with rtPA. Imaging demonstration of IPAI may facilitate the treatment with rtPA in this population. |
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