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Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence
First author：Li Ning
Corresponding author：Zhao xingquan
essential_information
2023-11-04
Published articles
Journal：Neuropsychiatric Disease and Treatment
Publication type: Original Contributions
IF(IF): 3.2
PMID: 37936866 Link To Pubmed Full text Download
Background And Purpose
Patients with acute non-disabling stroke or transient ischaemic attack (TIA) have a higher risk of subsequent recurrent stroke and cardiovascular events in the first year. Current guidelines for intravenous thrombolysis in patients with acute nondisabling stroke are controversial. The PRISMS study explored the safety and efficacy of alteplase thrombolytic therapy in nondisabling stroke patients, but had no yield definitive conclusion1. In addition to the premature termination of the study, another important reason was that they used the mRS scale and NIHSS scale as the main tools to evaluate the dysfunction, and the main outcome (mRS 0-1) was very close to the inclusion standard ( NIHSS 0-5) , so it was difficult to draw statistical differences. Gait speed is a sensitive and reliable quantitative index to evaluate patients' motor function and predict clinical outcomes. Gait speed, alone or incorporated into geriatric rating scales, is associated with mortality among community-dwelling individuals2. Study finds, slow walking speed increases the risk of ischemic stroke 3. Slow walking speed at discharge may be an independent predictor of complex vascular events in patients with mild stroke 4. We also found that intravenous thrombolysis may have association with gait and balance function in minor stroke and TIA in our previous study6. Therefore, we used walking speed as an evaluation index of motor function to explore the relationship between intravenous thrombolysis and walking speed in patients with non-disabling stroke and TIA.
Method
Methods: This observational study included patients with acute ischemic stroke with a National Institutes of Health Stroke Scale(NIHSS) score 0 to 5 at admission. The short-term outcomes at discharge and 3-month were analyzed including the modified Rankin Scale score, gait speed, Montreal Cognitive Assessment, Patient Health Questionnaire-9, General Anxiety Disorder-7 and Stroke Impact Scale-16. Multivariate regression models were performed to evaluate the association between intravenous thrombolysis and clinical outcomes.
Conclusion
Conclusion: Alteplase showed a suggestive benefit in function and motor outcomes in patients with low NIHSS score of 0–5.Meanwhile, female seemed more inclined to post-stroke emotional problems after alteplase treatment, which should be further explored in the future.
Main results
Results: A total of 1876 consecutive patients were included in the current analyses with 102 patients (5.4%) received alteplase and 1774 patients (94.5%) were in non-alteplase group. We found that 10.9% patients presented unfavorable functional outcome with a mRS ≥ 2 at 3-month. Patients with alteplase treatment had a more favorable outcome in SIS-16 at discharge (OR, 5.45; 95% CI, 2.22–8.68) and 3-month after stroke (OR, 2.34; 95% CI, 0.17–4.50). There was an association of alteplase with better gait speed in the restricted sample of age >60 (OR,0.14; 95% CI, 0.02–0.25), while an unfavorable effect was found in anxiety (OR, 2.23; 95% CI, 2.23, 0.91–3.55) and depression (OR, 1.54; 95% CI, 0.17–2.91) in female.