title: Thrombolysis in patients with lacunar stroke is safe: an observational study.
abstract: Research suggests that the etiology of lacunar stroke is different from that of other stroke subtypes. This could imply an altered response to thrombolysis, but data concerning the efficacy of rt-PA in lacunar stroke is limited and inconsistent. From our prospectively collected stroke database, we identified patients with an MRI-confirmed purely lacunar stroke that were treated in our Stroke Unit between 2004 and 2011. We compared both the clinical course (NIHSS, deterioration, mRS at 3 months) and the MRI findings between patients who either received or did not receive rt-PA. In comparison to patients who obtained standard medical care (n = 468), acute lacunar stroke patients treated with rt-PA (n = 69) were more severely affected on admission (median NIHSS of 5 vs. 3; p < 0.001) and presented less frequently with a lacunar syndrome (74 vs. 88 %; p = 0.003). The clinical course was more favorable in patients treated with rt-PA (median NIHSS improvement of 3 vs. 1; p < 0.001), while functional deficit after 3 months was similar in both groups (median mRS of 2; p = 0.211). Overall complication rates did not differ significantly between the two groups, but while we did not detect symptomatic intracranial hemorrhage, hemorrhagic transformation was more frequent in thrombolyzed patients (11.6 vs. 1.9 %; p = 0.001). Patients with acute lacunar stroke benefited from thrombolysis without additional complications. Thus, patients with suspected acute lacunar stroke or lacunar syndrome should not be treated differently than other stroke populations.
authors.affiliation: Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany, griebe@neuro.ma.uni-heidelberg.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Griebe
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fischer
authors.forename: Micha
authors.initials: M
authors.lastname: Kablau
authors.forename: Philipp
authors.initials: P
authors.lastname: Eisele
authors.forename: Marc E
authors.initials: ME
authors.lastname: Wolf
authors.forename: Anastasios
authors.initials: A
authors.lastname: Chatzikonstantinou
authors.forename: Achim
authors.initials: A
authors.lastname: Gass
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hennerici
authors.forename: Kristina
authors.initials: K
authors.lastname: Szabo
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000473:pathology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D059409:Stroke, Lacunar / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator