Response to Systemic Thrombolysis in Different Ischemic Stroke Subtypes

Background: Evidence based treatment of acute ischemic stroke is intravenous administration of fibrinolytic agents within the first 4.5 hours.The source of cerebral vessel occlusion may be important for recanalization.Current study is designed to find which ischemic stroke subtype benefit more from systemic thrombolysis.Methods: Hospital records of patients who received only IV-tPA for acute ischemic stroke treatment are outlined retrospectively.Four etiologic subtypes, large arterial atherosclerosis, cardioembolism, lacunar infarct and other uncommon causes of stroke are included, patients with strokes due to undetermined source are excluded.The reduction of NIHSS score more than 7 or a final NIHSS score between 0-2 are defined as good response to thrombolytic treatment.The percentages of patients reaching to favourable outcome on day 1,7 and 90 are compared between different subtypes together with intracranial bleeding and mortality.Results: Among 231 patient included, the good response rate was similar in strokes due to large arterial atherosclerosis and cardioembolism at day 1, 7 and 90 (28.8% versus 25% on day 1, 38.8% versus 35.8% on day 7 and 51.3% versus 50.8% on day 90).Lacunar infarcts did not respond to IV-tPA dramatically in the first week (25%), however improve better at the end of three months (75%).The rate of good responders did not significantly vary between different subtypes in all time points (OR: 0.784 at day 1, OR: 0.946 at day 7, OR: 1.219 day 90, P>.05).Low blood glucose level at the admission and low onset-to-time were significant determinant of early good response after adjustment (P<.05).Intracranial bleeding was higher in cardio embolic strokes.. Conclusion:The etiologic and physiopathologic mechanism of acute ischemic stroke does not affect the response to fibrinolytic treatment.Especially delays in infusion or high initial blood sugar levels lead to poor response.Withholding thrombolysis in patients with definite subtypes or the reverse have not been recommended.