Patients with Acute Lacunar Infarction Have Benefit from Intravenous Thrombolysis

Živanović, Željko; Gubi, Marina; Vlahović, Dmitar; Milićević, Marija; Jovićević, M; Lucic, Aleksandra; Ruzicka-Kaloci, Svetlana; Radovanović, Biljana; Žikić, Tamara Rabi; Žarkov, Marija; Popović, Nemanja; Slankamenac, Petar

doi:10.1016/j.jstrokecerebrovasdis.2018.10.020

“…2,3,13 Accordingly, we found END was significantly associated with an unfavorable outcome at discharge. IVT was proven to improve functional outcome in lacunar stroke patients at discharge 31 and at 90 days 3 ; however, ours and other studies 32,33 did not replicate the results. Caution must be taken that the rate of patients who received IVT is very low (4.7%) in our study, making it difficult to achieve statistical significance.…”

Section: Discussioncontrasting

confidence: 83%

Risk factors related to early neurological deterioration in lacunar stroke and its influence on functional outcome

Tan

¹

,

Zhao

²

,

Dai

³

et al. 2022

International Journal of Stroke

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Objective To identify risk factors for early neurological deterioration (END) in acute lacunar stroke patients, and its influence on functional outcome. Methods Consecutive acute lacunar stroke patients defined by MRI between January 2018 and June 2020 were included in the study. END was defined as any persisting increase in National Institutes of Health Stroke Scale (NIHSS) score of ≥2 points post admission, and favorable outcome was defined as a modified Rankin Scale (mRS) of 0-2 at discharge. Univariable and multivariable logistic regression were performed to identify risk factors related to END, as well as the influence of END on functional outcome. Results Among a total of 638 lacunar stroke patients (420 males (65.8%), median age 66 years (IQR:56-74)), 108 (16.9%) developed END, and 94.4% (102/108) of the END occurred within 72 h post admission. Admission NIHSS score (aOR 1.132, 95%CI 1.046-1.225, p=0.002), female (aOR 2.752, 95%CI 1.277-5.933, p=0.010), admission systolic blood pressure (SBP) (160-179mmHg) (aOR 9.395, 95%CI 4.310-20.479, p<0.001) and admission SBP (≥180mmHg) (aOR 16.030, 95%CI 5.991-42.891, p<0.001) were significantly associated with END. Delay time from onset to admission (aOR 0.995, 95%CI 0.990-1.000, p=0.031) , SBP dropping (≥20mmHg) within 3 days or when END occurred (aOR 0.037, 95%CI 0.016-0.086, p<0.001) and thalamic lacunar infarction (aOR 0.098, 95%CI 0.012-0.827, p=0.033) were inversely associated with END. END (aOR 12.374, 95%CI 6.881-22.254, p<0.001) and higher admission NIHSS score (aOR 1.488, 95%CI 1.359-1.629, p<0.001) predicted unfavorable outcome at discharge. Conclusion END in lacunar stroke patients is common and is associated with unfavorable outcome. Admission high SBP is a potentially modifiable risk factor for prevention of END, but this needs further investigation.

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“…The prominent feature of clinical treatment is intravenous (IV) thrombolysis (IVT). In thrombolytic drugs, plasminogen activators can dissolve fibrin in thrombi and promote the recanalization of blocked vessels, thus saving patients' lives in a timely manner [12][13][14]. However, IVT still has limitations.…”

Section: Introductionmentioning

confidence: 99%

Clinical Effect of Digital Subtraction Angiography Combined with Neurointerventional Thrombolysis for Acute Ischemic Cerebrovascular Disease and Its Influence on Vascular Endothelial Function and Oxidative Stress

Wang

¹

,

Guan

²

,

Wang

³

2022

Oxidative Medicine and Cellular Longevity

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Objective. Ischemic cerebrovascular disease is a commonly seen vascular disorder in clinical practice. Given the difficulty of drug therapy to achieve ideal curative effects, interventional therapy has gradually become the preferred treatment for the disease. This research primarily discusses the short-term efficacy of digital subtraction angiography- (DSA-) guided neurointerventional thrombolysis for acute ischemic cerebrovascular disease (AICVD) and its influence on vascular endothelial function (VEF) and oxidative stress (OS). Methods. All the clinical data of 162 patients diagnosed with AICVD and treated between June 2019 and December 2021 were collected and analyzed retrospectively. They were assigned to two cohorts according to the difference in interventional methods: a conventional group (CG) given recombinant tissue plasminogen activator (rt-PA) therapy and an observation group (OG) intervened by DSA-guided neurointerventional thrombolysis. The two groups were compared with respect to short-term treatment efficacy, the National Institutes of Health Stroke Scale (NIHSS) score, cerebral hemodynamics, and VEF and OS indexes. Results. The short-term efficacy was better in OG (93.98%) than in CG (82.28%). After treatment, the NIHSS score decreased in both cohorts with obvious differences within the group at different time points, and the posttreatment NIHSS score was lower in OG as compared to CG. OG had higher Q m and V m while lower W v , Z cv , and R v than CG. Higher endothelial-dependent flow-mediated dilatation (FMD) was observed in OG, as well as lower ankle-brachial index (ABI) and pulse wave velocity (PWV). And the posttreatment MDA was lower while SOD, GSH-Px, and TAC were higher in OG compared with those on CG. All the above differences were of statistical significance ( P < 0.05 ). Conclusions. DSA-guided neurointerventional thrombolysis is highly effective in the treatment of AICVD, which can not only effectively improve patients’ neurological function and cerebral hemodynamics but also mitigate VEF injury and help to alleviate patients’ OS.

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“…The prominent clinical treatment for ICD is intravenous thrombolysis, which can promote the recanalization of the blocked blood vessels and save the life of patients, because of the plasminogen activator in the thrombolytic drug which dissolves the fibrin in the thrombus (7)(8)(9). However, the deficiency is that intravenous thrombolysis only works within the first 4 h after the onset of the disease and has certain contraindications for patients (10).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of neurointervention combined with intravenous thrombolysis in the treatment of ischemic cerebrovascular disease and its influence on neurological function and prognosis of patients

Li

¹

,

Lou

²

,

Chang

³

et al. 2020

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The present study aimed to investigate the efficacy of neurointervention combined with intravenous thrombolysis in the treatment of ischemic cerebrovascular disease (ICD) and its influence on the neurological function and prognosis of patients. A total of 119 patients with ICD admitted to Xinxiang Central Hospital (Xinxiang, China) from May 2013 to September 2015 were selected. Among them, 65 patients were enrolled in the control group and treated with intravenous thrombolysis, whereas the other 54 patients were enrolled in the observation group and were treated with intravenous thrombolysis combined with neurointervention. The National Institute of Health Stroke Scale (NIHSS) system was used to evaluate the neurological function of patients after treatment. Kaplan-Meier survival curve analysis was carried out to assess the survival of patients. The total effective rate, complications, vascular recanalization and the hospitalization time after treatment were compared between the two groups. The NIHSS scores at 1, 3 and 6 months after treatment were statistically lower in the observation group than those in the control group (P<0.05). The total effective rate and total vascular recanalization in the observation group were higher than those of the control group (P<0.05). The incidence of complications in the observation group was statistically lower than that in the control group (P<0.05). In conclusion, neurointervention combined with intravenous thrombolysis can not only effectively improve the diseased blood vessels of patients and restore the damaged nerve function, but also reduce the incidence of complications. Moreover, neurointervention combined with intravenous thrombolysis is safe and can ensure a better quality of life of patients. Patients and methods General information. A total of 119 patients with ICD admitted to Xinxiang Central Hospital (Xinxiang, China)

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Patients with Acute Lacunar Infarction Have Benefit from Intravenous Thrombolysis

Cited by 8 publications

References 23 publications

Risk factors related to early neurological deterioration in lacunar stroke and its influence on functional outcome

Risk factors related to early neurological deterioration in lacunar stroke and its influence on functional outcome

Clinical Effect of Digital Subtraction Angiography Combined with Neurointerventional Thrombolysis for Acute Ischemic Cerebrovascular Disease and Its Influence on Vascular Endothelial Function and Oxidative Stress

Efficacy of neurointervention combined with intravenous thrombolysis in the treatment of ischemic cerebrovascular disease and its influence on neurological function and prognosis of patients

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