Study On The Safety And Efficacy Of Intravenous Thrombolysis In Patients With Acute Ischemic Stroke Complicated With Microbleeds

Objective:To study the safety and efficacy of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in patients with acute ischemic stroke complicated with cerebral microbleeds(CMBs).Methods:1.A retrospective study of 182 patients with acute ischemic stroke who received intravenous thrombolysis in the four wards of the Department of Neurology,Tianjin Hutong Hospital,was performed within 4.5 hours of the onset of symptoms from July 2015 to May 2017.Patients were divided into groups according to whether the MR showed microhemorrhage and received thrombolytic therapy:(1)MRI showed microhemorrhage while receiving rt-PA intravenous thrombolytic therapy in patients(microhemorrhage group)51 patients;(2)MRI display Microbleeds,46 patients without rt-PA thrombolytic therapy(microbleeds without thrombolytic therapy);(3)MRI showed no microbleeds and rt-PA thrombolytic therapy was performed(no microbleeding thrombolysis group)85 cases.Patients undergoing intravenous thrombolysis(2013 AHA/ASA Guidelines for the Early Treatment of Acute Ischemic Stroke and 2014 Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke)were treated with rt-PA intravenous thrombolysis.2.Record the gender,age,risk factors for stroke in each group,and record laboratory test results.Record NIHSS scores at admission,1h,24 h,and 7d after treatment(National Institute of Health Stroke)Scale score,National Institute of Health Stroke Scale,patients' mRs score(modified Rankin Scale,Modified Rankin Scale)after 90 days of follow-up treatment,and record and evaluate intracranial hemorrhage and intracerebral hemorrhage after treatment in each group.Incidence and mortality.3.Prognosis and safety assessment:(1)Short-term prognosis: NIHSS scores decreased by >4 or more or neurological deficits completely disappeared at 24 h and 7d after treatment,and the prognosis was good;the NIHSS score decreased less than 4 points is called a poor prognosis in the near future.(2)Long-term prognosis evaluation: Patients with 90-day mRS score of 0-2 after receiving treatment are referred to as long-term prognosis;90-d mRS scores of >2 points are known as poor long-term prognosis.(3)Safety evaluation: The incidence of symptomatic intracerebral hemorrhage and mortality after treatment were used as evaluation criteria.Results:1.Compared with patients in microbleeding nonthrombolytic group and microbleeding thrombolysis group,compared with patients without microbleeding thrombolysis group,NIHSS score,stroke related risk factors,gender,age,hospital admission There were no statistically significant differences in the baseline results of laboratory tests and CMB counts(P>0.05).2.The hemorrhage thrombolysis group was compared with the microbleed non-thrombolytic group.Twenty-seven patients(72.5%)had hemorrhagic thrombolysis group and 23 patients(50.0%)had microbleeds non-thrombolysis group.There was significant difference between the two groups(P< 0.05);After 7 days of treatment,the patients with good prognosis of neurological dysfunction improved in 43 patients with hemorrhagic thrombolysis(84.3%),and 29 patients with microbleeds without thrombolytic therapy(63.0%).There was a significant difference between the two groups(P< 0.05).3.When the long-term prognosis was good at 3 months,there were 46 patients(90.2%)in the hemorrhage group and 34 patients(73.9%)in the non-thrombolysis group.There was a difference between the two groups(P< 0.05).4.There was no non-symptomatic intracerebral hemorrhage in patients with microbleeding and thrombolytic therapy,and 1 patient with symptomatic intracerebral hemorrhage and intracerebral hemorrhage,accounting for 2.0%,and 1 patient with death,accounting for 1.0%.Non-symptom patients with microbleeding in non-thrombolysis group Intracranial hemorrhage occurred in one patient(2.2%),symptomatic intracerebral hemorrhage in one patient(2.2%),and death in one patient(2.2%);there was no statistical difference between the two groups(P>0.05).5.Microhemorrhagic thrombolysis group compared with patients without microbleeding thrombolysis group,patients with good prognosis of neurological function after 24 hours of treatment hemorrhage thrombolysis group 37 cases,accounted for 72.5%,no hemorrhage thrombolysis group 55 cases,accounting for 64.7%,the difference was not statistically significant(P gt;0.05);after 7 days of treatment,patients with good neurological function prognosis microhemorrhage thrombolysis group 43 cases,accounting for 84.3%,no micro hemorrhage thrombolysis group 66 cases,accounting for 77.6% There was no significant difference(P>0.05).6.Patients with good long-term prognosis at 3 months,microbleeding and thrombolysis group had 46 patients,accounting for 90.2%,and 73 patients without microbleeding and thrombolysis group accounted for 85.9%,with no statistical difference(P>0.05).7.One case of symptomatic intracerebral hemorrhage occurred in patients with microbleeding and thrombolytic therapy.The incidence was 2.0%,non-symptomatic intracranial hemorrhage was 0,and the mortality rate was 2.0%.There was no symptomatic intracerebral hemorrhage in 1 patient with microbleeding.The rate was 2.2%,and there was one case of non-symptomatic intracranial hemorrhage with an incidence of 2.2% and a mortality rate of 2.2%.There was no significant difference between the two groups(P>0.05).Conclusion:1.Head MRI examination can confirm the presence of microbleeds.Compared with the non-thrombolysis group,the short-term prognosis and long-term prognosis of patients treated with thrombolysis were significantly different from those in the non-thrombolysis group.2.There was no statistically significant difference between the ratio of symptomatic intracranial hemorrhage and non-symptomatic intracerebral hemorrhage and the mortality and microbleeding in the non-thrombolytic group in the microbleeding thrombolytic group.3.There was no statistically significant difference between the recent hemorrhagic thrombolysis group and the patients with microbleeding and thrombolytic therapy.There was no significant difference in the incidence of symptomatic intracranial hemorrhage and non-symptomatic intracerebral hemorrhage and mortality between the microbleeding thrombolysis group and the non-hemorrhagic thrombolysis group.