Analysis Of The Efficacy And Prognosis Of Patients With Cerebral Infarction In The Middle Cerebral Artery Distribution After Intravenous Thrombolysis

Part ? Effect and prognosis of intravenous thrombolysis in cerebral infarction patients with the middle cerebral artery of different location of lesionsObjective To investigate the effect and prognosis of intravenous rt-PA thrombolysis in cerebral infarction patients with the middle cerebral artery(MCA)of different location of lesions and to analyze influencing factors of the clinical prognosis.Methods We consecutively collected patients with acute infarct in the MCA territory(n=75)in Changzhou No.2 people's hospital,and all patients underwent intravenous thrombolysis therapy within the 4.5-hour time window.The sites of MCA lesion were classified into the origin of the MCA(type I),the MCA trunk distal to the lenticulostriate arteries(type II)and the branches of the MCA(type III);Early symptom improvement was defined as 24-hour NIHSS score decreased ? 4 points or down to 0 point after intravenous thrombolysis;Clinical data were obtained and compared among patients with the middle cerebral artery(MCA)of different location of lesions.Logistic regression analysis was used to confirm the relevant factors of prognosis 90 days after index stroke.Results Among 75 enrolled patients,22(29.3%)were classified as type I and 16(21.3%)as type II and 37(49.3%)as type III.Atrial fibrillation(x2 = 3.904,P = 0.048),baseline National Institutes of Health Stroke Scale(NIHSS)score(t = 11.435,P < 0.001)and 24-hour NIHSS score(t = 21.349,P < 0.001)were different among three groups.In early symptom improvement(x2 = 10.433,P = 0.005),type I(6 cases(27.3%))was poor than type II(11 cases(68.8%))and type III(25 cases(67.5%)),but in symptomatic intracranial hemorrhage(x2 = 9.916,P =0.003),7-days mortality(x2 =17.954,P < 0.001)and 90 d m RS score(t = 14.276,P < 0.001),it was highest among three groups.After 90 d follow-up,the good outcome was found in 56 cases(74.7%)and poor outcome in 19 patients(25.3%).Meanwhile,the sites of MCA lesion(x2 = 19.424,P < 0.001),thrombolysis time(x2 = 9.764,P = 0.002),baseline NIHSS score(t = 4.808,P = 0.032)and 24-hour NIHSS score(t = 4.937,P = 0.029)were significantly different among two groups.Multivariate analysis revealed that patients with the sites of MCA lesion(OR = 2.633,95%CI 1.119~6.197,P = 0.027),thrombolysis time(OR = 7.603,95%CI 1.561~37.043,P = 0.012),baseline NIHSS score(OR = 3.622,95%CI 1.068~12.285,P = 0.039)worsened outcome.Conclusion Different lesion sites of MCA may indicate different effect and prognosis in patients with intravenous thrombolysis.And,the sites of MCA lesion,thrombolysis time and baseline NIHSS score were independent risk factors for prognosis in cerebral infarction patients with intravenous thrombolysis.Part II Influence of Intravenous thrombolysis on prognosis of coexisting moderate to severe leukoaraiosis patients with acute ischemic strokeObjective To investigate influence of Intravenous thrombolysis on prognosis of coexisting moderate to severe leukoaraiosis patients with acute ischemic stroke and to analyze influencing factors of the clinical prognosis.Methods We consecutively collected patients with acute ischemic stroke on middle cerebral artery occlusion(n=83)in Department of Neurology or emergency between November 2013 to Mary 2017,and all patients were divided into two groups according to whether intravenous thrombolysis therapy(IVT)or not.The Fugl-Meyer scale score was used to assess motor function outcome and the National Institutes of Health Stroke Scale score was used to assess neurologic function.Clinical data were obtained and compared among patients with two groups.Following up 90 days,the primary clinical endpoint events including stroke recurrence and death and the key secondary endpoint events including other vascular events after IVT were collected.Multivariate linear regression analysis was used to analysis the relevant factors of the motor function outcome after 90 days.Results Among 83 enrolled patients,29(34.9%)were classified as IVT group and 54(65.1%)as no IVT group.In IVT group,hemorrhagic transformation and symptomatic intracranial hemorrhage were observed 31.0% and 13.8% patients,which were higher than 9.3% patients and 1.9% patients in the group of no IVT(31.0% vs 9.3%;x2 = 6.086,P = 0.014).However,there was no significant difference in symptomatic intracranial hemorrhage.And there was no significant difference between the two groups in National Institutes of Health Stroke Scale(NIHSS)score and Fugl-Meyer rating scale(FMS)score at any point in time.But,two groups had a decline in 90-day FMS score(78.9±11.6 vs 73.1±38.5;83.0±11.2 vs 82.5±32.4).Following up 90 days,the primary clinical endpoints were obtained 29 patients(34.9%)which has 16 patients(19.3%)and 13 patients(15.7%)in stroke recurrence and death,respectively.No significant difference was found(x2 = 0.005,P = 0.946)in primary clinical endpoints between two groups.Multivariate linear regression analysis revealed that symptomatic intracranial hemorrhage(t = 2.151;P = 0.035),baseline NIHSS score(t = 3.003;P = 0.004)and recurrent stroke(t = 3.097;P = 0.003)were risk factors 90-day motor function recovery,but not thrombolytic selection(OR = 0.665,95%CI 0.289~1.531,P = 0.338).Conclusion Acute ischemic stroke patients with moderate to severe LA have higher risk of hemorrhagic transformation,but not symptomatic intracranial hemorrhage after intravenous thrombolysis.However,there is no associated with thrombolytic selection and motor function recovery.