Title:Efficacy and Safety of Alteplase on Treatment of Acute Single Small
Subcortical Infarction
Volume: 19
Issue: 3
Author(s): Kilanga Marcelinus, Hongbing Liu, Ke Zhang, Ce Zong, Hongxun Yang, Bo Song, Yuan Gao*Yuming Xu*
Affiliation:
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- National Health Council Key Laboratory of Prevention and Treatment of Cerebrovascular Disease
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, China
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- National Health Council Key Laboratory of Prevention and Treatment of Cerebrovascular Disease
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, China
Keywords:
Single small subcortical infarction, early neurological deterioration, functional outcome, intracerebral hemorrhage, small vessel disease, modified rankin scale.
Abstract:
Background: Single Small Subcortical Infarction (SSSI) is an isolated small infarction in
the territory of perforating artery with a maximum diameter of 20 mm in axial Diffusion-Weighted
Imaging (DWI). About 20 to 30% of SSSI patients were reported to have Early Neurological Deterioration
(END) in the acute phase, which brought adverse effects on long-term outcomes. The effect
of the alteplase on the outcome of SSSI, especially END and long-term outcomes, was ambiguous.
Objective: The study aims to find out the efficacy and safety of intravenous recombinant tissue
Plasminogen Activator (rt-PA) on long-term and short- outcomes of patients with SSSI as compared
to patients who received standard medical care.
Methods: The patients were retrospectively screened from a stroke registry of the neurology department
of 1st Affiliated Hospital of Zhengzhou University from January 2013 to December 2020.
Based on treatment modality, patients were dichotomized into alteplase and standard medical care
groups. To minimize confounding factors in subgroups, a propensity score matching analysis was
done. The primary outcome was the favorable functional outcome 3 months after stroke onset, defined
by attaining a score of ≤2 points on the modified Rankin scale (mRS), secondary outcome was
the prevention of occurrence of END, defined as an increase of ≥2 points in the total score or
≥1point on motor subunit in the National Institutes of Health Stroke Scale (NIHSS) score within 72
hours after admission, safety features were symptomatic intracranial hemorrhage (sICH) or death.
Multivariate analysis was employed to find the efficacy and safety of alteplase in the treatment of
SSSI.
Results: A total of 717 patients with anterior circulation SSSI were selected, and 132 were included
in the final analysis. Forty-five patients were treated with alteplase within 4.5 hours and 87 with
standard medical care, and 44 pairs were successfully matched by propensity score. Pre-match data
showed that the alteplase thrombolysis group showed a higher proportion of favorable outcomes at
3-month follow-up [OR=0.315, 95%CI:0.106, 0.931, P = 0.037] but did not reduce the incidence of
END compared with the non-thrombolytic group [OR = 1.033, 95%CI:0.417,2.554, P = 0.943].
Post-match data showed that the alteplase group also showed a higher proportion of favorable outcomes
at 3-month follow-up [OR = 0.247, 95%CI: 0.074, 0.830, P = 0.024]; however, it did not
reduce the incidence of END compared with the non-thrombolytic group [OR = 1.241, 95%CI:
0.433,3.554, P = 0.688]. There was one case of asymptomatic ICH in alteplase treated patients.
Conclusion: Patients with SSSI in the anterior circulation are more likely to achieve 3 months favorable
outcomes than those who were treated with standard medical care; however, treatment with
alteplase may not prevent the occurrence of END.
