Intravenous tissue plasminogen activator thrombolysis in patients without major arterial occlusion seems to be safe and effective.

摘要

BACKGROUND: It is not clear whether tissue plasminogen activator (t-PA) thrombolysis in patients without major arterial occlusion is effective or safe. METHODS: Consecutive anterior circulation stroke patients treated with t-PA within 3 h of onset were studied. The patients were divided into three groups according to magnetic resonance angiography findings before t-PA infusion: ICA group, ICA occlusion; MCA group, M1 and M2 occlusion, and no occlusion group. Clinical characteristics, the presence of hemorrhagic transformation on T* at 24 h after t-PA thrombolysis, and outcome at 3 months were compared among the three groups. RESULTS: 112 patients were enrolled. The no occlusion group had 21 (18.8) patients, the ICA group had 29 (25.9), and the MCA group had 62 (55.4). The frequency of hemorrhagic transformation was only 4.8 in the no occlusion group (31.0 for the ICA group, and 48.4 for the MCA group, p = 0.0012). At 3 months after t-PA therapy, 61.5 of the no occlusion group had a favorable outcome (modified Rankin score 0-1), which was the highest among the three groups (15.0 for the ICA group, and 41.5 for the MCA group, p = 0.0203). CONCLUSION: Intravenous t-PA therapy in acute stroke patients without major artery occlusion seems to be safe and effective.