Thrombolysis in ischemic stroke without arterial occlusion at presentation

Area of Science:

• Neurology
• Vascular Medicine
• Emergency Medicine

Background:

• Randomized trials of intravenous tissue-type plasminogen activator (tPA) for stroke typically exclude patients without visible arterial occlusion.
• The efficacy of tPA in ischemic stroke patients without arterial occlusion on vascular imaging is largely unknown.

Purpose of the Study:

• To investigate the efficacy and safety of thrombolytic therapy in patients with ischemic stroke and no visible arterial occlusion on initial vascular imaging.
• To determine if thrombolysis improves clinical outcomes in this specific patient population.

Main Methods:

• Retrospective, multicenter study of 256 ischemic stroke patients with no vascular occlusion on imaging.
• Patients were divided into two groups: those who received thrombolytic therapy (n=103) and those who did not (n=153).
• Primary outcome was excellent clinical outcome (modified Rankin Scale 0-1 at 90 days); safety outcomes included symptomatic intracerebral hemorrhage.

Main Results:

• Patients receiving thrombolysis had significantly more frequent excellent outcomes (OR 3.79, P<0.01).
• Symptomatic intracerebral hemorrhage was more frequent in the thrombolysis group (4.9% vs 0.7%, P=0.04).
• Thrombolysis improved excellent outcomes in nonlacunar strokes (OR 4.90, P<0.01) and perfect outcomes in lacunar strokes (OR 8.25, P<0.01).

Conclusions:

• This study suggests that thrombolytic therapy can be beneficial for patients presenting with ischemic stroke even when no arterial occlusion is detected on initial vascular imaging.
• The findings provide crucial evidence supporting the use of thrombolysis in this previously understudied group of stroke patients.