Retrospective And Comparative Analysis Of The Efficacy And Safety Of Intravenous Thrombolysis And Intravascular Therapy In Patients With Moderate And Severe Posterior Circulation Ischemia Stroke

Objective:We aim to retrospectively analyzed the clinical data of patients with acute moderate and severe posterior circulation ischemia stroke treated in the hospital to explore the efficacy and safety of intravenous thrombolysis or intravascular therapy in the treatment of acute moderate and severe posterior circulation ischemia stroke.Methods:From January 2016 to December 2018,we collected the clinical data of 53 patients with acute moderate and severe posterior circulation ischemia stroke who were treated in the intravenous thrombolysis time window(≤4.5h)in Chenzhou NO.1 People’s Hospital,including 30 patients in the intravenous thrombolysis group and 23 patients in the intravascular therapy group.Etiology was classified according to the trial of org 10172 in acute stroke treatment(TOAST).Patients in the intravenous thrombolysis group were treated with recombinant tissue plasminogen activator(rt-PA)for intravenous thrombolysis,and patients in the intravascular therapy group were treated with blood vessels recanalization within the time window for intravascular therapy after intravenous thrombolysis.All patients received the national institutes of health stroke scale(NIHSS)score at admission,NIHSS score assessments were at 24 hours and 14 days after treatment,and modified Rankin scale(mRS)score assessment were at 90 days after treatment(0 ~ 2 = good prognosis,3 ~ 6 = poor prognosis).Modified thrombolysis in cerebral infarction(mTICI)was evaluating during operation to evaluate the perfusion classification of the patients in the intravascular therapy group,and levels 2b~3 were defined as successful blood vessels recanalization.Results:1.There was no significant difference in age,gender,risk factors(hypertension,diabetes,coronary heart disease,atrial fibrillation,smoking history),blood pressure at admission,mRS score before stroke,NIHSS score at admission,onset-to-needle time(ONT),door-to needle time(DNT)between the intravenous thrombolysis group and the intravascular therapy group.2.Among the enrolled patients,the most common etiological type was large artery atherosclerosis type(69.81%),other type was cardioembolism type(30.19%).3.After 24 hours,the NIHSS score of the intravenous thrombolysis group was 9.28±5.48,while that of the intravascular therapy group was 8.17±6.44,there was no significant difference between the two groups.After 14 days of treatment,the NIHSS score of the intravenous thrombolysis group was 7.90±6.14,and that of the intravascular therapy was 5.78±6.99,there was no significant difference between the two groups.After 90 days of treatment,the rate of good prognosis of the intravenous thrombolysis group was 36.67%,and that of the intravascular therapy group was 65.22%,showing a significant difference between the two groups(P=0.039,P<0.05).4.There was no statistically significant difference in the mortality within 90 days between the intravenous thrombolysis group and intravascular therapy group after treatment.The incidence of symptomatic intracranial hemorrhage and in the intravenous thrombolysis group was 10.00%,and that of the intravascular therapy group was 34.78%,showing a significant difference between the two groups(P=0.027,P<0.05).5.In the intravascular therapy group,the rate of good prognosis of the successful blood vessels recanalization group was 82.35%,and that of the unsuccessful blood vessels recanalization group was 16.67,showing a significant difference between the two groups(P=0.004,P<0.05).Conclusion:Large artery atherosclerosis is the most important cause of acute moderate and severe posterior circulation ischemia stroke.Compared with intravenous thrombolysis alone,intravascular therapy can better improve the prognosis of patients with acute moderate and severe posterior circulation ischemia stroke within 4.5 hours,but the incidence of symptomatic intracranial hemorrhage after intravascular therapy is higher than that after intravenous thrombolysis alone.