Efficacy Of Intravenous Recombinant Tissue Plasminogenactivator Thrombolysis Therapy For Cardioembolic Stroke

Objective: To observe the efficacy of intravenous recombinant tissue plasminogen activator(rt-PA)thrombolysis therapy for cardioembolic stroke.Methods: Acute ischemic stroke patients who accepted the intravenous thrombolysis treatment within 4.5 hours from the onset were included,All patients were classified in two groups: cardioembolic and non-cardioembolic according to TOAST criteria,The early neurological improvement,long-term prognosis,the symptomatic intracranial hemorrhage(s ICH)and the mortality after thrombolysis were observed in the two groups.Results: A total of 94 patients were included in the study,with 33 patients are cardioembolic and 61 are non-cardioembolic.Group of patients with cardioembolic current smoking less than non-cardioembolic group[9.1 %(3/33)VS 36.1 %(22/61),χ2=7.892,P=0.005];The proportion of atrial fibrillation in cardiac stroke group is obviously higher than that of the non-cardiac stroke group[72.7%(24/33)VS 4.9%(3/61),χ2=48.096,P<0.001],Others have no statistically significance;The 24-hour and discharge NIHSS score and NIHSS score decreased comparing difference was statistically significance(P<0.05),The proportion of early neurological improvement of the Cardiac stroke group at discharge is lower than that of the Non-Cardioembolic group,the difference was statistically significance(P < 0.05);The rate of good long-term prognosis of cardioembolic stroke is lower than that of non-cardiac stroke group[24.2%(8/33)vs 47.5%(29/61),χ2=4.870,P=0.027];the rate of s ICH and mortality of the cardiac stroke is more than that of non-cardiac stroke group[18.2%(6/33)VS 4.9%(3/61),χ2=4.352,P=0.037],[18.2%(6/33)VS 6.6%(4/61),χ2=4.451,P=0.035],Multivariate logistic regression model for outcomes,After adjusted for all confounding variables(age,blood glucose,antiplatelet or antithrombotic before thrombolysis 24 h,current smoking,atrial fibrillation,baseline NIHSS score),the rate of sICH of the cardiac stroke group is about five times than that of the cardiac stroke group(OR:5.12;95%CI:0.13-21.45:P=0.039),the mortality of the cardiac stroke group is about three times than that of the cardiac stroke group(OR:2.98;95%CI:0.74-12.76;P=0.048),The proportion of early neurological improvement and good long-term prognosis in cardioembolic Stroke is lower than that of non-cardiac stroke group(OR:0.41;95%CI:0.13-1.02:P=0.045),(OR:0.36;95%CI:0.14-0.93:P=0.031).Conclusion: The early effect and long-term prognosis of the cardioembolic stroke is worse than that of the non-cardioembolic after intravenous rt-PA thrombolysis therapy,the rate of s ICH and mortality of cardiac stroke is more than that of the non-cardiac stroke.So,we should actively prevent the occurrence of cardiac stroke.