Efficacy and safety of intravenous and intra-arterial thrombolysis with tissue plasminogen activator in Chinese patients with acute ischemic stroke: a comparative study

Abstract

Objective To compare the efficacy and safety of intravenous and intra-arterial thrombolysis with tissue plasminogen activator in Chinese patients with acute ischemic stroke.Methods Patients with acute ischemic stroke,consecutively registered in our database from 2005 to 2010,were included.Admission demographics,time window,procedure delay in hospital,route of thrombolysis,dose of tissue plasminogen activator,stroke severity,laboratory tests and vital signs of these patients were collected.CT manifestations and TOAST subtypes were obsevred.Outcome variables included hemorrhagic transformation,re-canalization of responsible vessels,favorable functional outcome 90 d after thrombolysis and mortality were evaluated.Univariate and multivariate logistic regression were used to select the potential variables and compare the differences between the two kinds of route in thrombolysis.Results A total of 96 patients were included with one loss of follow-up.Forty-three were male (44.8％) and 53 female.Median age was 72 years,median body weight 58.5 kilograms,and median time window 4.3 hours.Sixty-four patients received intravenous thrombolysis and 32 patients intra-arterial thrombolysis.Favorable outcome was achieved in 43.8％ patients 90 d after thrombolysis with a mortality reaching 17.9％.Univariate analysis showed intra-arterial thrombolysis had a much higher cost (47623.6 vs 25699.8 RMB),longer procedure delay (3.17 h vs 1.73 hours) and time window (5.54 vs 3.58 hours),and lower dose (20 vs 50 mg) as compared with intravenous thrombolysis (P＜0.05);however,no significant differences were found between the 2 groups in re-canalization of responsible vessels (64.9％ vs 53.8％),hemorrhagic transformation (25％ vs 31.3％),favorable outcome (45.3％ vs 40.6％) and mortality (14.7％ vs 3.2％).Multivariate logistic regression indicated that route of thrombolysis did not predict unfavorable outcome (OR=0.54,P=0.824,95％ CI:0.00-131.46);re-canalization could independently predict the functional outcome (OR=0.11,P=0.027,95％ CI:0.02-0.78),while the route of thrombolysis itself did not influence the re-canalization.Conclusion In patients with acute ischemic stroke,the treatment efficacy and safety of intravenous and intra-arterial thrombolysis with tissue plasminogen activator are similar,not enjoying significant difference in hemorrhagic transformation and mortality. Key words: Acute ischemic stroke; Intra-arterial thrombolysis; Thrombolytic therapy; Tissue plasminogen activator; Comparative study