Data_Sheet_2_Efficacy and Safety of Intravenous Thrombolysis on Acute Branch Atheromatous Disease: A Retrospective Case–Control Study.PDF

Background and Objective: Branch atheromatous disease (BAD) is distinctive from large-artery atherosclerosis and small-vessel disease, which is single subcortical infarction caused by the occlusion of perforator's orifice. This study aimed to indicate whether intravenous thrombolysis (IVT) with alteplase could prevent early neurological deterioration (END) and improve functional outcome for patients with BAD within 4.5 h after symptom onset.Methods: We retrospectively analyzed data collected from patients with BAD who were admitted to our hospital from January 2015 to August 2019. To investigate the efficacy and safety of IVT, subjects were classified into alteplase and control groups. A propensity score matching analysis was performed to control substantial heterogeneity of subgroup. The coprimary outcomes were END that is defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after stroke, and favorable outcome at 3 months after stroke that defined by a score of 0–1 point on the modified Rankin scale (mRS).Results: A total of 135 patients were eventually enrolled in this study (n = 51 for the alteplase group and n = 84 for the control group). Additionally, 42 pairs of subjects were successfully matched by propensity score matching. Intravenous alteplase within 4.5 h after stroke onset reduced the incidence of END [unadjusted odds ratio (OR), 3.32; 95% confidence interval (CI), 1.06–10.37] and improved the clinical outcome at 3 months after stroke, with more patients achieving favorable functional prognosis (mRS, 0–1 point; unadjusted OR, 0.25; 95% CI, 0.10–0.62). Patients in the alteplase group were more likely to be independent (mRS, 0–2 points) at 3 months after stroke (unadjusted OR, 0.33; 95% CI, 0.12–0.90). The rate of death or dependence (mRS, ≥4 points) in the alteplase group was also markedly lower than that in the control group (unadjusted OR, 4.06; 95% CI, 1.03–16.02).Conclusion: Our findings indicated that intravenous thrombolysis may be a safe and effective therapy for patients with BAD.

背景与目标：分支动脉粥样硬化病（BAD）与大型动脉粥样硬化和小血管疾病有所不同，后者是由穿支动脉开口闭塞引起的单发皮质下梗死。本研究旨在探讨静脉溶栓（IVT）联合阿替普酶是否能在症状出现后4.5小时内预防早期神经功能恶化（END）并改善BAD患者的功能预后。方法：我们对2015年1月至2019年8月期间入住我院的BAD患者数据进行回顾性分析。为探究IVT的有效性和安全性，受试者被分为阿替普酶组和对照组。采用倾向评分匹配分析以控制亚组间的显著异质性。主要终点为END，即在卒中后7天内美国国立卫生研究院卒中量表（NIHSS）评分增加≥2分，以及卒中后3个月的有利预后，由改良Rankin量表（mRS）评分0-1分定义。结果：共有135名患者最终被纳入本研究（阿替普酶组n=51，对照组n=84）。此外，通过倾向评分匹配成功匹配了42对受试者。在卒中发作后4.5小时内给予静脉阿替普酶可降低END的发生率[未调整的比值比（OR），3.32；95%置信区间（CI），1.06-10.37]，并改善卒中后3个月的临床预后，更多患者实现了良好的功能预后（mRS，0-1分；未调整OR，0.25；95%CI，0.10-0.62）。阿替普酶组患者在卒中后3个月更可能保持独立（mRS，0-2分）（未调整OR，0.33；95%CI，0.12-0.90）。阿替普酶组的死亡或依赖率（mRS，≥4分）也显著低于对照组（未调整OR，4.06；95%CI，1.03-16.02）。结论：我们的研究结果表明，静脉溶栓可能是一种安全有效的治疗BAD患者的疗法。