Effect Of Intravenous Thrombolysis For Patients With Mild Atherosclerotic Ischemic Stroke

Objective: 1.To investigate the short-term and long-term effects and safety of recombinant tissue-plasminogen activator(rt-pa)intravenous thrombolysis in patients with atherosclerotic mild stroke;2.To explore the efficacy and safety of thrombolytic therapy for atherosclerotic mild stroke with different OTT(onset to treatment time)and different baseline NIHSS;3.To explore the possible risk factors for early neurological deterioration after thrombolysis in patients with mild atherosclerotic stroke.Methods: Patients with mild stroke who were admitted to the department of neurology,the first affiliated hospital of dalian medical university between May 2017 and May 2019 were collected.A total of 186 patients with atherosclerotic disease were screened out,including 91 in the thrombolytic group and 95 in the control group.The short-term and long-term efficacy and safety of thrombolytic therapy in patients with mild atherosclerotic stroke were evaluated by comparing the changes in the national institutes of health stroke scale(NIHSS)score and the modified Rankin score(m RS)on90 days between the two groups.At the same time,patients in the thrombolytic group were divided into the subgroup of thrombolytic time(OTT= 1-3h and OTT=3-4.5h)and the subgroup of baseline NIHSS score(NIHSS= 0-3 and NIHSS=4-5),to explore whether thrombolytic time and baseline NIHSS score had an impact on the thrombolytic results.The thrombolytic group was divided into END group and non-END group according to whether or not the early neurological deterioration occurred,relevant factors of patients with early neurological deterioration in the thrombolytic group were analyzed to explore possible risk factors for early neurological deterioration after thrombolysis in patients with mild atherosclerotic stroke.Results:1.There were no statistical differences in age,gender,admission blood pressure,NIHSS score,previous history and personal history between the thrombolytic group and the control group.In terms of short-term prognosis,the mean NIHSS score of patients in the thrombolytic group at 24 h and 7d was significantly lower than the baseline NIHSS score,while the mean NIHSS score in the control group was lower than the baseline value at 7d and higher than the baseline value at 24 h.The effective rate of the two groups at 24 h and 7d was higher in the thrombolytic group than in the control group.In terms of long-term prognosis,the proportion of good prognosis(m Rs 0-1 score)in the thrombolytic group at 90 d was 87.9%,much higher than that in the control group(73.7%).The above differences were statistically significant.In terms of recurrence rate,2.2% of patients in the thrombolytic group had recurrent stroke within 3 months,while8.4% of patients in the control group had recurrence,although more than in the thrombolytic group,the difference was not statistically significant(2=3.538,P=0.06,OR=0.244,95%ci 0.05?1.183).In terms of safety,both the thrombolytic group and the control group showed 1 case of intracranial hemorrhage conversion,with an incidence of 1.1% and a similar conversion rate,and the 2 cases were asymptomatic intracranial hemorrhage.In terms of mortality,during the 90 d follow-up,1 patient died in the thrombolytic group and no death in the control group.2.In the comparison of thrombolytic efficacy of the baseline NIHSS score subgroup(0-3 points and 4-5 points),the effective rate of the 0-3 subgroup on 7d was lower than that of the 4-5 subgroup(67.6% vs73.9%),but there was no statistical difference(p=0.574).In terms of safety,intracranial hemorrhage occurred in 1 of the 4-5subgroups,while no intracranial hemorrhage occurred in the 0-3 subgroups.3.The comparison of thrombolytic results of the onset to treatment(OTT)subgroup(< 3h and 3-4.5h)showed that the effective rate of the < 3h group was 80%,higher than that of the 3-4.5h group(56.1%),and the difference was statistically significant(p=0.014).There was no significant difference in the long-term prognosis between the two groups(88% vs 87.8%,p=0.977).In terms of safety,1 case of intracranial hemorrhage occurred in the 3-4.5h group,and no case of intracranial hemorrhage occurred in the < 3h group.4.In the thrombolytic group,there were 8 cases(8.8%)of early neurological deterioration,and 21 cases(22.1%)of early neurological deterioration in the control group,and the difference between the two groups was statistically significant(P = 0.012,? 2 = 6.260,or = 0.340,95% CI 0.142-0.813).In the thrombolytic group,there were 8 in the END group and 83 in the non-end group.In single factor analysis,two groups of patients' gender,personal history(smoking,drinking),past medical history(high blood pressure,diabetes,cerebral infarction),disease before the presence of TIA,hospital blood pressure level and blood lipid levels,blood sugar and white blood cell levels before thrombolysis and no statistically significant difference(p > 0.05),and admission of baseline NIHSS score and fasting glucose was statistically significant difference(p <0.05).The above risk factors with p<0.1,namely,admission NIHSS score,fasting glucose and OTT,were included in the binary logistics regression analysis model.The results showed that high fasting glucose was an independent risk factor for END after thrombolysis(p =0.049,OR =1.304,95%ci 1.001-1.698).Conclusion:1.Rt-pa intravenous thrombolytic therapy can improve the short-term and long-term prognosis of patients with mild atherosclerotic stroke,reduce the occurrence of early neurological deterioration,but cannot reduce the recurrence of stroke;Thrombolytic therapy does not increase the risk of intracerebral haemorrhage conversion,and its mortality is very low.2.After intravenous thrombolysis in patients with mild atherosclerotic stroke,patients with a baseline NIHSS score of 0-3 have better long-term prognosis and lower incidence of intracranial hemorrhage than patients with a baseline NIHSS score of 4-5.3.Compared with patients with onset within 3-4.5h,rt-pa intravenous thrombolysis within 0-3h can achieve a better short-term prognosis and has a lower incidence of intracranial hemorrhage.4.High fasting glucose is an independent risk factor for early functional deterioration in patients with mild atherosclerotic stroke after thrombolysis.