Study on multi-modality magnetic resonance imaging-based intravenous thrombolysis with rt-PA in acute ischemic stroke

Objective To evaluate the efficiency and safety of multi-modality magnetic resonance imaging (MRI)-based intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke. Methods In accordance with the criterion of thrombolysis trial of National Institute of Neurological Disorders and Stroke (NINDS), 48 patients with new onset of acute ischemic stroke were enrolled. All patients were normal in computed tomography (CT) scanning and were scanned by multi-modality MRI. All patients who met the inclusion and exclusion criterion were treated intravously by rt-PA 0.90 mg/kg. Compared the National Institutes of Health Stroke Scale (NIHSS) score before, and 24 h, 21 d and 90 d after treatment. Barthel index (BI) score before and 21 d, 90 d after treatment, and modified Rankin score at 90 d after treatment were also assessed. Results Twenty patients who met the criterion were evaluated. The NIHSS score before, and 24 h, 21 d and 90 d after treatment was (11.40 ± 4.29), (6.55 ± 4.33), (3.95 ± 3.50), and (0.75 ± 0.99), respectively, and there were statistical differences (P 0.01 or P = 0.010). BI score before treatment was (18.75 ± 5.45), and increased to (60.25 ± 33.48) and (92.25 ± 12.09) respectively at 21 d and 90 d after treatment, and statistical differences were also found (P 0.01, for all). At 90 d after treatment, there were 14 cases (14/20, 70%) with modified Rankin score 0-1, 6 cases (6/20, 30%) with score 2-3. No symptomatic intracranial hemorrhage was seen and no death occurred. Conclusion Intravenous thrombolysis with rt-PA (0.90 mg/kg) is a safe and effective treatment for patients with acute ischemic stroke within 4.50 h after onset. Multi-modality MRI is helpful to choose those patients who may obtain benefit from thrombolysis therapy and may exclude those who are at risk of bleeding after such treatment.