Analysis Of Intravenous Alteplase Thrombolysis On Mild Acute Ischemic Stroke With Different Onset To Needle Time

ObjectiveMild ischemic stroke(MIS)is usually characterized by acute onset and mild symptoms.At present,there is a controversy about the efficacy and safety of intravenous Recombinant tissue plasminogen activator(rt-PA)thrombolysis in MIS within 0-4.5h from the last known normal time of symptom onset or the last known normal time before treatment.Evidence-based studies indicate that different Onset to needle time(ONT)may affect the evaluation of the efficacy of intravenous rt-PA in MIS.Therefore,the purpose of this study was to observe the improvement of early neurological impairment and the difference in long-term prognosis after intravenous rt-pa thrombolytic therapy in MIS patients in different ONT,and to explore the factors affecting the long-term prognosis of thrombolytic therapy in MIS patients.Method A total of 95 patients with MIS were selected from the indications for intravenous rt-PA thrombolytic therapy that visited our hospital from January,2015 to September,2018,andcorresponding contraindications were excluded.The patients were divided into two groups observation,according to the difference ONT(0-3.0h vs 3.0-4.5h).Different queue were observed before and after treatment,24 h,7d,14 d,Using National Institute of Health Stroke Scale(NIHSS)to evaluate neural deficiency,and Modified Rankin Scale(mRS)is using to assess the disabling at resident,90 d after intravenous rt-PA thrombolysis.At the same time,we observed and recorded the deterioration of neurological function defects,systemic bleeding and other complications as well as the occurrence of etiological classification.We observed the differences in the efficacy and safety of intravenous rt-pa thrombolysis in MIS patients from different ONT,and explored the factors affecting the long-term prognosis of thrombolysis in MIS patients.Result1.For the 95 MIS patients,the difference in NIHSS between before and after intravenous thrombolysis was statistically significant(p<0.001),and the incidence of bleeding complications after thrombolysis was 6.32%.To the end point of observation,a total of 83 patients had mRS 0-1,and 1 patient died due to the recurrence of large area acute cerebral infarction.Compared with the non-disabling rate before the onset,the difference was statistically significant(87.37%vs53.68%,p=0.01).2.The improvement rate of neurological impairment in MIS patients was statistically significant(83.33%vs61.70%,p=0.039).However,there was no statistically significant difference between ONT at 14 d in NIHSS and 90 d non-disability rate,hospitalization days and bleeding complications(p>0.05).3.Compare to other CISS etiological types,the rate of deterioration of nerve function defect in ALL patients was higher than that of other etiological types(p< 0.05).4.Hospitalization days with bleeding complications were longer than those without bleeding complications(p=0.029).5.Multivariate binary Logistic regression was performed on the long-term prognosis of MIS,and it was found that they was mainly related to the NIHSS(OR=2.431,95%CI 1.142-5.174,p=0.021)and the type of SC(OR=11.263,95%CI 1.060-119.620,p=0.045),but not significantly related to the ONT.Conclusion1.Intravenous rt-PA thrombolysis in ONT 3-4.5h MIS patients was safe,and the long-term good prognosis was comparable to that of ONT 0-3h MIS patients with intravenous rt-PA.2.Compared with other etiological types,patients with ALL are more prone to neurologic deterioration after thrombolysis.3.Compared withLAA,CS is a risk factor for long-term prognosis of thrombolysis in MIS patients.The higher the NIHSS,the worse the long-term prognosis.