Study on the clinical prognosis of patient with middle cerebral artery recanalization after intravenous thrombolysis by rt-PA for acute ischemic stroke

YIN Hang; ZHANG Peilan

doi:10.3969/j.issn.1002-7386.2015.08.003

Abstract：Objective To evaluate the clinical prognosis of patient with middle cerebral artery recanalization after intravenous thrombolysis by recombinant tissue plasminogen activator ( rt-PA) for acute ischemic stroke.Methods The data of 552 patients with acute ischemic stroke from September 2013 to September 2014,who were treated by rt-PA intravenous thrombolysis in Neurology Department of Tianjin Huanhu Hospital,were retrospectively analyzed.All the patients underwent head MRA examination before and 24h after intravenous thrombolysis,and the recanalization condition of middle cerebral artery was evaluated according to TICI revascularization classification criteria.According to the results of MRA examination 24h after thrombolysis,the patients were divided into revascularization group ( n =188) and recanalization failure group (364 cases) . The neurologic impairment scoring and therapeutic effect before and 24h after intravenous thrombolysis were assessed according to National Institute of Health Stroke Scale (NIHSS).The prognostic evaluation was performed according to modified Rankin Scale ( mRS ) .The incidences of intracranial hemorrhage ( ICH ) , symptomatic intracranial hemorrhage ( SICH ) after thrombolysis,the patient's mortality,the condition of neurologic impairment recovery and prognosis were analyzed and compared statistically between the two group.Results The good recovery rates and good prognosis rates at 7d and 90d after thrombolysis in recanalization group were significantly higher than those in recanalization failure group ( P <0.05).No symptomatic ICH cases were found in recanalization group,but there were 6 cases of asymptomatic ICH.There were no significant differences in the incidences of intracranial hemorrhage after thrombolysis between two groups (3.2% vs 6.6%, P >0.05),in the incidences of hemorrhage in the other position (15.9%vs 20.3%, P >0.05),and mortality duration of hospital stay (0 vs 1.6%) .Conclusion The neurologic impairment symptoms of patients with middle cerebral artery recanalization are obviously improved after intravenous thrombolysis by rt-PA for acute ischemic stroke.After intravenous thrombolysis the clinical prognosis in patients with revascularization is much better than that of patients without revascularization.