Clinical study of low ⁃ dose rt ⁃ PA combined with transcranial Doppler ultrasonography assisted intravenous thrombolysis

Abstract

Objective To investigate the efficacy and safety of low dose rt⁃PA combined with transcranial Doppler ultrasonography (TCD) in the intravenous thrombolysis treatment of acute ischemic stroke. Methods A total of 139 patients with acute ischemic stroke admitted to Anhui No. 2 Provincial People's Hospital from July 2016 to May 2019 were randomly divided into the rt⁃PA standard dose group (0.90 mg/kg, total dose≤90 mg), low dose group (0.60 mg/kg, total dose≤60 mg) and low dose combined with TCD group (combined treatment group). TCD was used to continuously monitor the blood flow of middle cerebral artery for 2 h at the beginning of thrombolysis in the combined treatment group. TCD was only performed before and 2 h after thrombolysis in the standard dose group and low dose group. Two hours after thrombolysis, the recanalization rates of intracranial vessels in different treatment groups were compared. National Institutes of Health Stroke Scale (NIHSS) score was used to evaluate the severity of clinical symptoms in each group, and the incidence of symptomatic intracranial hemorrhage 24-48 h after thrombolysis was recorded. The self⁃care ability of 90 d after thrombolytic therapy was evaluated by modified Rankin Scale (mRS), and the mortality rate was calculated. Results The recanalization rate in the combined treatment group were higher than those in the standard dose group (P=0.037) and low dose group (P=0.030), and the NIHSS score 2 h after thrombolysis was lower than that in the standard dose group (P=0.046) and low dose group (P=0.026); the incidence of symptomatic intracranial hemorrhage (P=0.017, 0.024) and 90 d mortality (P=0.005, 0.016) in the low dose group and combined treatment group were lower than those in the standard dose group. Conclusions Low dose rt⁃PA combined with TCD assisted intravenous thrombolysis can improve the recanalization rate without increasing the risk of symptomatic intracranial hemorrhage and death.

doi：10.3969/j.issn.1672⁃6731.2021.04.014