Efficacy of Intravenous Thrombolysis for the Prognosis of Branch Atheromatous Disease

Branch atheromatous disease (BAD) is often resistant to treatment, and the efficacy of intravenous thrombolysis (IVT) using recombinant tissue-type plasminogen activator remains uncertain. This study aimed to evaluate the effect of IVT on the prognosis of patients with BAD. We conducted a retrospective cohort study of BAD patients who arrived at our hospital within 4.5 hours of symptom onset. Patients were divided into two groups based on treatment: the IVT group (n = 11) and the non-IVT group (n = 87). In the IVT group, alteplase (0.6 mg/kg) was administered intravenously. Clinical outcomes were compared between these groups. Additionally, within the IVT group, we performed a subgroup analysis, defining patients with a modified Rankin Scale (mRS) score of ≤2 at discharge as having a favorable outcome and those with an mRS score of ≥3 as having an unfavorable outcome. Patients in the IVT group were significantly younger than those in the non-IVT group (62.4 years vs. 75.4 years; p = 0.0003). No significant differences were observed between the two groups in the National Institutes of Health Stroke Scale (NIHSS) scores at admission and discharge or in mRS scores at discharge. In the IVT group, patients with a favorable prognosis (n = 5) were significantly younger than those with a poor prognosis (n = 6) (53.4 years vs. 69.8 years; p = 0.0088). However, NIHSS scores at admission did not significantly differ between the favorable and poor prognosis groups. No intracranial hemorrhagic complications were observed in the IVT group. This study found no clear benefit of IVT on the prognosis of BAD patients, underscoring the need for novel treatment strategies. Age appears to influence the prognosis of BAD patients treated with IVT, consistent with findings in ischemic stroke in general. This study had a small sample size for the IVT group and was a retrospective, single-center observational study. Therefore, a large-scale prospective randomized controlled trial is needed to evaluate the efficacy of IVT for BAD in the future.