Intravenous Thrombolysis in Patients with Acute Lacunar Infarction: Preliminary Study

Abstract

Background: The use of recombinant tissue plasminogen activator (rt-PA) in acute lacunar infarction has been debated because of its benign natural course and different pathomechanisms. The purpose of this study is to show the safety and feasibility of intravenous thrombolysis in acute lacunar infarction. Methods: We retrospectively reviewed data from our acute stroke registry which as collected 53 prospective patients underwent intravenous thrombolysis from May 2006 to December 2006. Among them, 10 patients were subdivided into lacunar infarction. Clinical profiles, radiological data, and clinical outcomes were obtained. We defined excellent clinical outcome as National Institutes of Health Stroke Scale score 0 or 1 and an improvement of the score more than 3 on follow-up examination at 7 days. We also defined good clinical outcome as modified Rankin Scale score 0 or 1 on followup examination. Results: Mean values of onset-to-door, door-to-computed tomography, and door-to-needle time were 92.5¡¾46.1, 21.1¡¾10.9, and 41.9¡¾11.6 minutes, respectively. Among 10 patients, 5 patients had clinical pure motor stroke, 3 patients were clinically ataxic hemiparesis, and 2 had clinical sensorimotor stroke. The excellent clinical outcome at 7 days was observed in 3 patients (30%) and good clinical outcome at 7 days was also obtained in 8 patients (80%). Adverse events including intracranial hemorrhage occurred none of the patients. Conclusion: This study suggests that intravenous thrombolysis with rt-PA in acute lacunar infarction may be applicable in clinical settings. However, this study has several limitations - no control groups, too small numbers enrolled patients, and no long-term follow-up results. (Korean J Stroke 2007;9:108-112)