Study of clinical outcomes after thrombolytic therapy in Mongolian adults with acute ischemic stroke

Abstract

Background: Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is the primary pharmacological therapy that was approved for treatment within 4.5 h of acute ischemic stroke (AIS) onset, to rapidly restore cerebral blood flow and prevent the expansion of the penumbra into ischemic core, but the efÏcacy of IVT in AIS patients is not well-studied in Mongolia. Aim: The present study aimed to determine the effectiveness of IVT and the subgroup of patients who will benefit from IVT in Mongolian adults with AIS within 4.5 h. onset. Materials and Methods: A retrospective observational study was conducted on the clinical, National Institutes of Health stroke severity score (NIHSS), radiological, and laboratory data of 105 AIS patients who received rt-PA (alteplase) between 2013 and January 2023 at the stroke center of Shastin Third Central Hospital and analyzed. Clinical outcome was defined as “Favorable” and “Poor” (modified Rankin Scale score 0-2 vs 3-6) at 3 months including in-hospital mortality. Symptomatic intracerebral hemorrhage was defined according to the Safe Implementation of Thrombolysis in Stroke Monitor Study. Binary logistic regression models were used to assess the relationship between IVT and modified Rankin Scale (mRS). Results: The mean onset to needle time in all patients was 203.78±44.15 min (range: 77-286 min). During 3-months follow-up period, 58 patients (55.2%) had a “Favorable” outcome, 47 patients (44.8%) had a “Poor” outcome, including 19 death cases (18.1%). Factors predicting “Favorable” outcome were age <65 years (p=0.038), the National Institute of Health Stroke Scale (NIHSS) <15 (p<0.001), small vessel occlusion (р<0.001) and cardioembolism (p=0.019). Independent factors predicting “Poor” outcome were NIHSS at admission >15 (OR 7.573, 95% CI 2.526-22.710, p<0.001), occlusion of large artery (OR 15.365, 95% CI 3.548-66.517, p<0.001) and DRAGON score >5 (Dense cerebral artery sign, age, glucose level on admission, onset to treatment time, NIHSS on admission score) (OR 5.228, 95% CI, 5.44716.845, p<0.001). Conclusion: Mild to moderate baseline stroke severity, cardioembolic stroke, and small vessel occlusion, relatively younger Mongolian patients (<65 years) benefit from recombinant tissue plasminogen activator.