Intravenous tissue plasminogen activator in acute branch atheromatous disease: Does it prevent early neurological deterioration?

Abstract

Early neurological deterioration (END) and poor outcome frequently occur in lenticulostriate artery (LSA) infarction due to branch atheromatous disease (BAD). We evaluate whether the tissue plasminogen activator (tPA) can prevent END and improve the outcome by comparing with anti-platelet treatment in LSA infarction due to BAD. We enrolled the patients with LSA infarction due to BAD who arrived at the hospital within 24h from onset, and divided those into two groups by whether tPA was given or not. END and good outcome (modified Rankin score: 0-1) at 3months were examined between two groups. Consecutive 35 patients of LSA infarction due to BAD enrolled in this study. Nine patients were given tPA (tPA group) and 26 patients antiplatelets only (non-tPA group). Patients in tPA group showed no symptomatic hemorrhage. END occurred in 68.6% (24/35) of all patients, 66.7% (6/9) of tPA group and 69.2% (18/26) of non-tPA group (p=0.886). The proportion of good outcome at 3months were 25.7% in all patients, 22.2% (2/9) in tPA group and 26.9% (7/26) in non-tPA (p=0.781). tPA did not adequately prevent END, and did not show better outcome in LSA infarction due to BAD compared with antiplatelet therapy only. More effective treatment strategies are needed for prevention of END and favourable outcome in BAD.

Keywords: Acute stroke; Antiplatelet agents; Intravenous thrombolysis; Tissue plasminogen activator.