title: Intravenous tissue plasminogen activator in acute branch atheromatous disease: Does it prevent early neurological deterioration?
abstract: Early neurological deterioration (END) and poor outcome frequently occur in lenticulostriate artery (LSA) infarction due to branch atheromatous disease (BAD). We evaluate whether the tissue plasminogen activator (tPA) can prevent END and improve the outcome by comparing with anti-platelet treatment in LSA infarction due to BAD. We enrolled the patients with LSA infarction due to BAD who arrived at the hospital within 24h from onset, and divided those into two groups by whether tPA was given or not. END and good outcome (modified Rankin score: 0-1) at 3months were examined between two groups. Consecutive 35 patients of LSA infarction due to BAD enrolled in this study. Nine patients were given tPA (tPA group) and 26 patients antiplatelets only (non-tPA group). Patients in tPA group showed no symptomatic hemorrhage. END occurred in 68.6% (24/35) of all patients, 66.7% (6/9) of tPA group and 69.2% (18/26) of non-tPA group (p=0.886). The proportion of good outcome at 3months were 25.7% in all patients, 22.2% (2/9) in tPA group and 26.9% (7/26) in non-tPA (p=0.781). tPA did not adequately prevent END, and did not show better outcome in LSA infarction due to BAD compared with antiplatelet therapy only. More effective treatment strategies are needed for prevention of END and favourable outcome in BAD.
authors.affiliation: Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum, Yangsan 626-770, Republic of Korea.
authors.forename: Min-Gyu
authors.initials: MG
authors.lastname: Park
authors.affiliation: Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum, Yangsan 626-770, Republic of Korea.
authors.forename: Eun Hye
authors.initials: EH
authors.lastname: Oh
authors.affiliation: Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum, Yangsan 626-770, Republic of Korea.
authors.forename: Baik-Kyun
authors.initials: BK
authors.lastname: Kim
authors.affiliation: Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum, Yangsan 626-770, Republic of Korea. Electronic address: kppark@pusan.ac.kr.
authors.forename: Kyung-Pil
authors.initials: KP
authors.lastname: Park
mesh_terms: D000208:Acute Disease; D000328:Adult; D020144:Basal Ganglia Cerebrovascular Disease / Q000150:complications / Q000000981:diagnostic imaging; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000517:prevention & control*; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator
keywords: Acute stroke; Antiplatelet agents; Intravenous thrombolysis; Tissue plasminogen activator