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Stroke thrombolysis treatment is generally administered within 4.5 h, but a greater time window may be permitted depending upon the ischemic penumbra on neuroimaging. This observational cohort study investigated the outcomes of thrombolysis given within 12 h after symptom onset of lenticulostriate artery stroke. The population comprised 160 patients. Thrombolysis was administered via tissue plasminogen activator, alteplase (TPA). Thrombolysis was indicated by a mismatch between diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI), that is, an acute ischemic lesion on DWI without a corresponding lesion on T2WI. Demographics and medical history were compared with the modified Rankin scale (mRS) score, to reflect outcome. Patients with a favorable clinical outcome (mRS 0-1) had significantly lower hypertension, baseline NIH Stroke Scale (NIHSS) score, and admission systolic/diastolic blood pressure compared with patients with mRS 2-6. Lower admission systolic blood pressure and NIHSS score were significantly associated with favorable outcome. In patients either with IV-TPA within 4.5 h, or between 4.5 and 12 h, lower admission systolic blood pressure and/or NIHSS score similarly independently predict favorable outcome. However, in all groups, the onset-to-treatment time did not significantly influence the outcomes. We conclude that in our cohort higher admission systolic blood pressure and higher baseline NIHSS and not time were associated with poor outcome in patients with magnetic resonance-guided thrombolysis within 12 h of isolated lenticulostriate artery stroke, therefore loosening the traditionally perceived dependency of outcome on time., (© 2022. The Author(s).)

Background and Purpose: We aimed to determine the predictive factors for super-acute perforating artery infarctions (PAI) involving lenticulostriate arteries infarctions (LSAI), anterior pontine arteries infarctions (APAI) and thalamic arteries infarctions (TAI). Whether intravenous thrombolysis (iv-tPA) therapy would influence the clinical outcome was also studied., Methods: We analyzed 84 consecutive patients within 12h of stroke symptom onset from January 2008 to June 2015. All patients had an imaging-proven acute infarction in the perforating territory of LSA (n=53), TA (n=21) and APA (n=10). Favorable clinical outcome was defined as modified Rankin Scale ≤1 at 90days. Patients were divided into groups according to clinical outcome, lesion location and thrombolysis therapy. Baseline demographic data, past medical history, National Institutes of Health Stroke Scale (NIHSS) score and infarction volume were compared between groups., Results: Eighty-four patients were recruited (median age: 61y; 67.9% male). All patients with TAI (n=21), 34/53 (64.2%) patients with LSAI and 4/10 (40%) patients with APAI achieved favorable clinical outcome (mRS≤1). Ninety-day clinical outcome was associated with age, previous stroke, baseline NIHSS, infarct location, infarct volume. Intravenous thrombolysis improved 24h NIHSS, but was not significantly associated with favorable outcome at 90days. In multivariate analysis, only previous stroke/TIA (OR 0.09, 95%CI 0.01-0.68, p=0.020) and infarct volume (OR 0.64, 95%CI 0.43-0.96, p=0.032) were independently associated with the outcome of acute PAI at 90days., Conclusions: Previous stroke/TIA, infarct location and infarct volume were independently associated with the short-term clinical outcome of acute PAI., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Intravenous (i.v.) tissue-type plasminogen activator (tPA) is the only approved noninvasive therapy for acute ischemic stroke (AIS). However, after tPA treatment, the outcome of patients with different subtypes of stroke according to their vascular risk factors remains to be elucidated. We aim to explore the relationship between the outcome and different risk factors in patients with different subtype of acute strokes treated with i.v. tPA. Records of patients in this cohort were reviewed. Data collected and analysed included the demographics, vascular risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) scores, 90-day modified Rankin Scores (mRS), and subtypes of stroke. By using the 90-day mRS, patients were dichotomized into favorable versus unfavorable outcome in each subtype of stroke. We identified the vascular risk factors that are likely associated with the poor outcome in each subtype. Among 570 AIS patients received i.v. tPA, 217 were in the large artery atherosclerosis (LAA) group, 146 in the small vessel occlusion (SVO) group, and 140 in the cardioaortic embolism (CE) group. Lower NIHSS score on admission was related to favorable outcome in patients in all subtypes. Patients with history of dyslipidemia were likely on statin treatment before their admission and hence less likely to have elevated cholesterol level on admission. Therefore, there was a possible paradoxical effect on the outcome in patients with LAA and SVO subtypes of strokes. SVO patients with history of diabetes had higher risk of unfavorable outcome. SVO patients had favorable outcome if their time from onset to treatment was short. In conclusion, the outcome of patients treated with i.v. tPA may be related to different vascular risk factors associated with different subtypes of stroke.

Background: We sought to assess the association of left ventricle mass (LVM) indices with the functional outcome of acute ischemic stroke (AIS) patients after intravenous tissue plasminogen activator (IV-tPA)., Methods: Consecutive AIS patients with IV-tPA were recruited. LVM indices including LVM/weight, LVM/surface, and LVM/heightˆ(2.7) on echocardiogram during hospitalization were retrospectively reviewed. Outcome was 90-day modified Rankin scale (mRS) scores. Multivariate logistic regression was performed to analyze the association of LVM indices with outcome., Results: Between August 2010 and May 2014, 55 AIS patients (age range from 27 to 78 years, 69.1% men) with echocardiogram after thrombolysis were recruited. Lower baseline National Institutes of Health Stroke Scale (NIHSS; P = .009) and higher LVM indices (LVM/weight [P = .012], LVM/surface [P = .039], and LVM/heightˆ(2.7) [P = .045]) were significantly associated with 90-day favorable outcome (mRS, 0-2). In multivariate logistic regression analysis, LVM/weight independently predicted good outcome with an odds ratio of 3.89 (95% confidence interval, 1.05-14.42, P = .042) after adjustment for baseline NIHSS, onset-to-treatment time, hypertension, hemorrhagic transformation, and systolic left ventricle inner diameters., Conclusions: Higher LVM indices on echocardiogram are significantly associated with favorable outcome in stroke patients with IV-tPA, among which LVM/weight seems to be the most effective., (Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.)