Patients with Acute Lacunar Infarction Have Benefit from Intravenous Thrombolysis

Zeljko Zivanovic; Marina Gubi; Dmitar Vlahovic; Marija Milicevic; Mirjana Jovicevic; Aleksandra Lucic; Svetlana Ruzicka-Kaloci; Biljana Radovanovic; Tamara Rabi Zikic; Marija Zarkov; Nemanja Popovic; Petar Slankamenac

doi:10.1016/j.jstrokecerebrovasdis.2018.10.020

Patients with Acute Lacunar Infarction Have Benefit from Intravenous Thrombolysis

J Stroke Cerebrovasc Dis. 2019 Feb;28(2):435-440. doi: 10.1016/j.jstrokecerebrovasdis.2018.10.020. Epub 2018 Nov 6.

Authors

Affiliations

¹ University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: drzzivanovic79@gmail.com.
² University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia. Electronic address: gubimarina@gmail.com.
³ Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: vmdmitar@gmail.com.
⁴ Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: novisad56@gmail.com.
⁵ University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: dragan.jovicevic27@gmail.com.
⁶ University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: japanac09@gmail.com.
⁷ University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: ruzickakaloci@gmail.com.
⁸ Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: liludalasmultipas@gmail.com.
⁹ University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: tamara.r.zikic@gmail.com.
¹⁰ University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: zarkovns@gmail.com.
¹¹ University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: nenja021@yahoo.com.
¹² University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia. Electronic address: petars.slankamenac@gmail.com.

PMID: 30409747
DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.020

Abstract

Introduction: Usefulness of intravenous thrombolysis in patients with acute lacunar cerebral infarction is questionable. The aim of this study was to evaluate the efficacy and safety of intravenous thrombolysis in patients with lacunar infarction in comparison with patients with nonlacunar infarction as well as with patients with lacunar infarction who were not treated with intravenous thrombolysis.

Materials and methods: In the first part of the study, among patients with acute ischemic stroke treated with intravenous thrombolysis, characteristics and outcomes of 46 patients with lacunar and 221 patients with nonlacunar infarction were compared. In the second part, 46 patients with lacunar infarction treated with intravenous thrombolysis were compared with 45 lacunar infarction patients who were not treated with intravenous thrombolysis.

Results: Patients with lacunar infarction had a lower National Institutes of Health Stroke Scale score (9.2 versus 13.9, P < .001), a greater Alberta Stroke Program Early computed tomography (CT) score (9.7 versus 9.2, P = .002), a lower prevalence of atrial fibrillation (6.5% versus 41.2%, P < .001), and significantly more frequently an excellent outcome after 3 months (76.1% versus 36.2%, P < .001) compared with patients with nonlacunar infarction. Among patients with lacunar infarction, an excellent outcome at discharge was significantly more frequent in the intravenous thrombolysis group (41.3% versus 15.6%, P = .01), and the length of hospitalization was significantly shorter (9.5 days versus 14.3 days, P = .002). There was no hemorrhagic transformation among patients with lacunar infarction treated with intravenous thrombolysis.

Conclusion: Intravenous thrombolysis has proven to be effective and safe in patients with lacunar infarction and should always be applied if there are no absolute contraindications.

Keywords: Acute ischemic stroke; complications; intravenous thrombolysis; lacunar infarction; outcome.

Publication types

Comparative Study
Observational Study

MeSH terms

Administration, Intravenous
Aged
Clinical Decision-Making
Comorbidity
Female
Fibrinolytic Agents / administration & dosage*
Fibrinolytic Agents / adverse effects
Humans
Male
Middle Aged
Recovery of Function
Risk Factors
Stroke, Lacunar / diagnostic imaging
Stroke, Lacunar / drug therapy*
Stroke, Lacunar / physiopathology
Thrombolytic Therapy* / adverse effects
Treatment Outcome

Substances

Fibrinolytic Agents