Objective To evaluate the early effectiveness and risk of hemorrhagic transformation (HT) of
intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) of different causes.
Methods AIS patients treated with intravenous thrombolysis using rt-PA in Department of
Neurology of Shenzhen People's Hospital between September 2015 and September 2019 were
retrospectively included in this analysis. All the patients were grouped according to the Chinese
Ischemic Stroke Subclassification (CISS). Clinical effectiveness was defined as a decrease of
NIHSS score ≥4 points or NIHSS score decreasing to 0 point. The outcome at 24 hours and 7 days
after thrombolysis and risk of HT at 24 hours after thrombolysis in different groups were analyzed.
Results A total of 283 patients were included. The overall effective rate was 45.58% (n =129) at 24
hours after IVT, of which penetrating artery disease (PAD) group was 63.64% (n =35), large-artery
atherosclerosis (LAA) group was 54.69% (n =70), undetermined etiology (UE) group was 45.45%
(n =10), other etiology (OE) group was 23.08% (n =3), cardiogenic stroke (CS) group was 16.92%
(n =11). Comparison among groups showed that the effective rate of PAD group were better than that
of UE, OE and CS groups, and the P value was 0.015, 0.008 and 0.004, respectively; LAA group
was better than UE, OE and CS group, and the P value was 0.032, 0.011 and 0.009, respectively; UE
group was better than OE and CS groups, and the P value was 0.031and 0.019. The overall effective
rate was 68.20% (n =193) at 7 days after IVT, and the effective rate of PAD group was better than that
of CS group (72.73% vs 58.46%, P =0.009), the 7-day effective rate in patients under 55 years was
better than that in patients over 80 years (76.11% vs 55.56%, P =0.013). HT occurred in 23 patients
(8.13%), the HT rate of PAD group (1.82%) was lower than that of LAA, OE, UE and CS groups, the
P value was 0.025, 0.018, 0.004 and 0.001, respectively; and the HT rate of CS group (18.46%) was
higher than that of LAA, OE and UE groups, the P value was 0.005, 0.012 and 0.021, respectively.
The HT rate of patients over 80 years was higher than that of patients under 55 years (14.81% vs 6.19%,
P =0.002) and patients aged 55 to 79 (14.81% vs 8.39%, P =0.006).
Conclusions The early thrombolytic effect and HT risk were different in AIS patients with
different causes. PAD group had higher effective rate of thrombolysis and lower HT risk, while CS
group had lower effective rate and relatively higher HT risk. The younger the patient, the better the
thrombolysis effect and the lower the risk of HT.
