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Outcomes and risk factors of perforating and non-perforating middle cerebral artery infarctions after intravenous thrombolysis

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Abstract

The clinical symptoms of perforating arteries differ, and responses to intravenous thrombolytic therapy are heterogeneous. Here, we investigated the effect of intravenous thrombolytic therapy and the related factors influencing acute perforating and non-perforating middle cerebral artery infarctions. We analyzed 320 patients with acute middle cerebral artery infarction who received alteplase thrombolysis within 4.5 h of onset at two stroke centers from January 2016 to December 2019. Outcome measures included rates of a favorable functional outcome (modified Rankin Scale scores of 0–2), distribution of modified Rankin Scale scores, intracranial hemorrhage, and symptomatic cerebral hemorrhage at 14 days, with comparisons between perforating artery and non-perforating artery cerebral infarction groups. In the perforating vessel disease group, 12 cases (17.4%) of intracranial hemorrhage occurred, with symptomatic cerebral hemorrhage in three cases (4.3%); there were no significant differences between the perforating and non-perforating vessel disease groups (all P > 0.05). In the perforating vessel disease group, the only significant prognostic factor was the National Institutes of Health Stroke Scale score before thrombolysis (Exp(B) = 1.365; 95% confidence interval [CI] 1.124–1.659; P = 0.002), and the only significant risk factor for hemorrhagic transformation was previous perforator disease (Exp(B) = 0.078; P = 0.038). Regardless of whether an acute infarction is perforating or non-perforating, intravenous thrombolytic therapy can yield a favorable outcome. Therefore, intravenous thrombolysis should be actively administered to treat perforating artery infarctions with a high risk of disability.

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Data availability

Data are available upon reasonable request. Anonymized data will be shared by request from any qualified investigator.

Abbreviations

MCA:

Middle cerebral artery

IVT:

Intravenous thrombolysis

NIHSS:

National Institutes of Health Stroke Scale

DNT:

Door-to-needle time

mRS:

Modified Rankin scale

TOAST:

Trial of ORG 10172 in Acute Stroke Treatment

CH:

Cerebral hemorrhage

PAD:

Perforating artery disease

SCH:

Symptomatic cerebral hemorrhage

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Funding

This work was supported by the Special Project for Diagnosis and Treatment of Key Clinical Diseases in Suzhou (No. LCZX202029), Suzhou City Medical Device and New Medicine Clinical Trial Institutional Capacity Improvement Project (No. SLT202001), Suzhou Science and Technology Development Plan (No. SS2019048), Project of “Six Talent Peaks” of Jiangsu Province (No. SWYY-017), and Project of Huaguoshan Mountain Talent Plan—Doctors for Innovation and Entrepreneurship. Lianyungang Science and Technology Association Soft Project Research Funding Project (NO: Lkxyb2111).

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Author notes

  1. Hongyu Wei, Yiqing Wang, Yongjin Zhang and Shouyun Du have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, China

    Hongyu Wei, Yiqing Wang, Jiahui Shen, Xiaojing Li & Zenglin Cai

  2. Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China

    Yongjin Zhang & Hongjie Yan

  3. Department of Neurology, Guanyun People’s Hospital, Lianyungang, China

    Shouyun Du

  4. Artificial Intelligence & Neuro-Informatics Engineering (ARINE) Laboratory, School of Computer Engineering, Jiangsu Ocean University, Lianyungang, 222023, China

    Nizhuan Wang

  5. Department of Radiology, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, China

    Jianbing Zhu & Yi Wang

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  1. Hongyu Wei
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Correspondence to Zenglin Cai.

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The study protocol and consent documents were reviewed and approved by the Ethics Committee of Nanjing Medical University (NO: (2016)13).

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Wei, H., Wang, Y., Zhang, Y. et al. Outcomes and risk factors of perforating and non-perforating middle cerebral artery infarctions after intravenous thrombolysis. J Thromb Thrombolysis 53, 722–730 (2022). https://doi.org/10.1007/s11239-021-02620-2

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