Background and purpose: We sought to analyze the efficacy of magnetic resonance imaging (MRI)-guided thrombolysis in patients with lenticulostriate artery stroke (LSAS) within 12 hours after onset of symptoms.
Methods: LSAS patients identified on diffusion-weighted imaging (DWI) within 12h after onset of symptoms were assigned to receive intravenous alteplase (iv-tPA). DWI/ T2-weighte imaging (T2WI) mismatch -/+ was defined as an acute ischemic lesion on DWI with/without a corresponding lesion on T2WI in the territory of lenticulostriate artery. Favorable clinical outcome was defined as modified Rankin Scale (mRS) score <2 at 90 days. Baseline demographic data and medical history were compared between outcomes.
Results: There were 160 LSAS patients received iv-tPA (104 within 4.5h) in 2008-2018 who had MRI data before treatment. DWI/T2WI-mismatch was detected in 73.1% (117/160) of patients. Lower admission systolic blood pressure (SBP) was significantly associated with 90d mRS<2 [adjusted odds ratio (OR) 0.93, 95%CI 0.88-0.99, p=0.026]. In overall patients, whether they received iv-tPA within 4.5h or not and whether they had DWI/T2WI-mismatch or not did not significantly impact the outcome. In DWI/T2WI-mismatch (+) group, hypertension negatively associated with favorable outcome (adjusted OR 0.15, 95% CI 0.04-0.59, p=0.007). In DWI/T2WI-mismatch (-) group, iv-tPA within 4.5h was an independent predictor of 90d mRS<2 (adjusted OR 7.38, 95% CI 1.25-43.48, p=0.027).
Conclusion: MRI-guided iv-tPA within 12h is safe and effective for LSAS patients. Hypertension and higher admission SBP are associated with poor outcome. In patients who have no DWI/T2WI-mismatch, iv-tPA within 4.5h independently predicts favorable outcome.