Efficacy and Safety of Intravenous Thrombolysis on Acute Branch Atheromatous Disease: A Retrospective Case–Control Study

Abstract

Background and Objective: Branch atheromatous disease (BAD) is distinctive from large-artery atherosclerosis and small-vessel disease, which is single subcortical infarction caused by the occlusion of perforator's orifice. This study aimed to indicate whether intravenous thrombolysis (IVT) with alteplase could prevent early neurological deterioration (END) and improve functional outcome for patients with BAD within 4.5 h after symptom onset. Methods: We retrospectively analyzed data collected from patients with BAD who were admitted to our hospital from January 2015 to August 2019. To investigate the efficacy and safety of IVT, subjects were classified into alteplase and control groups. A propensity score matching analysis was performed to control substantial heterogeneity of subgroup. The coprimary outcomes were END that is defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after stroke, and favorable outcome at 3 months after stroke that defined by a score of 0–1 point on the modified Rankin scale (mRS). Results: A total of 135 patients were eventually enrolled in this study ( n = 51 for the alteplase group and n = 84 for the control group). Additionally, 42 pairs of subjects were successfully matched by propensity score matching. Intravenous alteplase within 4.5 h after stroke onset reduced the incidence of END [unadjusted odds ratio (OR), 3.32; 95% confidence interval (CI), 1.06–10.37] and improved the clinical outcome at 3 months after stroke, with more patients achieving favorable functional prognosis (mRS, 0–1 point; unadjusted OR, 0.25; 95% CI, 0.10–0.62). Patients in the alteplase group were more likely to be independent (mRS, 0–2 points) at 3 months after stroke (unadjusted OR, 0.33; 95% CI, 0.12–0.90). The rate of death or dependence (mRS, ≥4 points) in the alteplase group was also markedly lower than that in the control group (unadjusted OR, 4.06; 95% CI, 1.03–16.02). Conclusion: Our findings indicated that intravenous thrombolysis may be a safe and effective therapy for patients with BAD.

Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease

“…[ 13 ] Cerebral infarction due to BAD is more common in Asia, especially in China. [ 14 ] In recent years, some scholars have demonstrated that the fluctuation or progression of neurological function is closely related to BAD, [ 15 , 16 ] wherein the fluctuation of neurological function mainly involves the progression of motor deficits, which usually leads to severe disability. Unfortunately, only a few studies are focused on the treatment of BAD.…”

“…The NINDS trial showed that alteplase was the most effective drug for improving clinical outcomes of ischemic stroke. [ 17 ] Wu et al [ 16 ] demonstrated that rt-PA infusion within 4.5 hours after the onset of symptoms significantly improved the early improvement rate of clinical symptoms in hyperacute BAD patients. The current study (n = 580) showed that intravenous alteplase administered within 4.5 hours of stroke onset increased EDR (35.2%) and more patients had favorable outcomes, which is consistent with a recent study.…”

Predictive Factors for Early Neurological Deterioration after intravenous thrombolysis of Single Small Subcortical Infarction in the Territory of the Middle Cerebral Artery

“…However, early neurological deterioration (END), observed in the acute phase of the infarction and leading to unexpected severe disability status, is not rare in these patients [6][7][8]9]. At present, intravenous thrombolytic therapy (IVT) is still the rst choice of treatment for SSI within the thrombolysis time window, although there are some controversies regarding the use of thrombolysis in the small pawn (NIHSS score ≤ 3) [10][11][12] . However, studies have shown that despite receiving IVT, a subset of those patients will still have END, which can affect the patient's long-term functional outcome [7][8]13 ] .…”

Study protocol of Branch Atheromatous Disease-related stroke (BAD-study): a multicenter prospective cohort study

“…The rate of END following intravenous thrombolysis was estimated as 13.8%, measured by the deterioration of NIHSS score at 24 h (≥ 4) [12]. Intravenous thrombolysis seemed unable to prevent END and controversial about its effect on improving functional outcome among patients with BAD-related stroke [12,[17][18][19]. In addition, Seners P, et al found that strongest predictors for END were consistent across thrombolysed and non-thrombolysed acute ischemic stroke patients including hyperglycemia, proximal arterial occlusion, large infarcts, no recanalization or re-occlusion, and etc.…”