Matsubayashi Taiki, Fujiki Shuko, Muramatsu Ryoko, Furuki Misako, Obayashi Masato
Department of Neurology, National Hospital Organization Disaster Medical Center, Tokyo, JPN.
Cureus. 2025 Mar 27;17(3):e81301. doi: 10.7759/cureus.81301. eCollection 2025 Mar.
Branch atheromatous disease (BAD) is often resistant to treatment, and the efficacy of intravenous thrombolysis (IVT) using recombinant tissue-type plasminogen activator remains uncertain. This study aimed to evaluate the effect of IVT on the prognosis of patients with BAD. We conducted a retrospective cohort study of BAD patients who arrived at our hospital within 4.5 hours of symptom onset. Patients were divided into two groups based on treatment: the IVT group (n = 11) and the non-IVT group (n = 87). In the IVT group, alteplase (0.6 mg/kg) was administered intravenously. Clinical outcomes were compared between these groups. Additionally, within the IVT group, we performed a subgroup analysis, defining patients with a modified Rankin Scale (mRS) score of ≤2 at discharge as having a favorable outcome and those with an mRS score of ≥3 as having an unfavorable outcome. Patients in the IVT group were significantly younger than those in the non-IVT group (62.4 years vs. 75.4 years; p = 0.0003). No significant differences were observed between the two groups in the National Institutes of Health Stroke Scale (NIHSS) scores at admission and discharge or in mRS scores at discharge. In the IVT group, patients with a favorable prognosis (n = 5) were significantly younger than those with a poor prognosis (n = 6) (53.4 years vs. 69.8 years; p = 0.0088). However, NIHSS scores at admission did not significantly differ between the favorable and poor prognosis groups. No intracranial hemorrhagic complications were observed in the IVT group. This study found no clear benefit of IVT on the prognosis of BAD patients, underscoring the need for novel treatment strategies. Age appears to influence the prognosis of BAD patients treated with IVT, consistent with findings in ischemic stroke in general. This study had a small sample size for the IVT group and was a retrospective, single-center observational study. Therefore, a large-scale prospective randomized controlled trial is needed to evaluate the efficacy of IVT for BAD in the future.
分支动脉粥样硬化疾病（BAD）通常对治疗有抵抗性，使用重组组织型纤溶酶原激活剂进行静脉溶栓（IVT）的疗效仍不确定。本研究旨在评估IVT对BAD患者预后的影响。我们对症状发作后4.5小时内抵达我院的BAD患者进行了一项回顾性队列研究。根据治疗情况将患者分为两组：IVT组（n = 11）和非IVT组（n = 87）。在IVT组中，静脉注射阿替普酶（0.6 mg/kg）。比较了两组的临床结局。此外，在IVT组内，我们进行了亚组分析，将出院时改良Rankin量表（mRS）评分≤2的患者定义为预后良好，mRS评分≥3的患者定义为预后不良。IVT组患者明显比非IVT组患者年轻（62.4岁对75.4岁；p = 0.0003）。两组在入院和出院时的美国国立卫生研究院卒中量表（NIHSS）评分或出院时的mRS评分方面未观察到显著差异。在IVT组中，预后良好的患者（n = 5）明显比预后不良的患者（n = 6）年轻（53.4岁对69.8岁；p = 0.0088）。然而，预后良好组和预后不良组入院时的NIHSS评分无显著差异。IVT组未观察到颅内出血并发症。本研究未发现IVT对BAD患者预后有明显益处，强调了需要新的治疗策略。年龄似乎会影响接受IVT治疗的BAD患者的预后，这与一般缺血性卒中的研究结果一致。本研究IVT组样本量较小，且为回顾性单中心观察性研究。因此，未来需要进行大规模前瞻性随机对照试验来评估IVT对BAD的疗效。
