Thrombolysis may benefit patients with no visible occlusions on scans

Stroke patients without occlusions treated via thrombolysis fared better than patients who weren’t in a study published online July 29 in Stroke.

Pursuing the question of whether or not the treatment was as beneficial in patients with nonlacunar stroke as it was in lacunar stroke, researchers led by Sourabh Lahoti, MD, of the University of Kentucky’s Department of Neurology in Lexington, and colleagues enrolled 256 patients in a retrospective study. Of those, 103 received thrombolysis.

According to Lahoti et al, approximately 40 percent of patients receiving thrombolytic therapy may receive a treatment that had not been fully proven beneficial for their stroke condition.

They found that patients who had thrombolysis scored better on the modified Rankin Scale. Excellent outcomes, as defined as a 0 to 1 on the modified Rankin Scale, occurred in 58 percent of patients who underwent thrombolysis, while only 40 percent of patients who did not undergo thrombolysis had an excellent outcome. Even so, Lahoti et al found that symptomatic hemorrhage happened in 4.9 percent of thrombolysis patients as opposed to 0.7 percent of patients who did not undergo thrombolysis.

In a subanalysis, lacunar stroke was found in less than half of the patients enrolled. Fifty-one percent of patients who had a nonlacunar stroke and had thrombolysis had an excellent outcome as opposed to the 30 percent of patients with nonlacunar stroke who did not undergo thrombolysis. Nonlacunar patients who underwent thrombolysis also had an increased rate of symptomatic hemorrhage (6.1 percent) as compared to those who did not (1 percent).

Excellent outcomes were seen in both the thrombolysis and no thrombolysis groups who had lacunar strokes (65 percent and 63 percent, respectively), however perfect outcomes occurred significantly more frequently in those who underwent thrombolysis (37 percent vs. 15 percent).

One possible explanation Lahoti et al gave for why improvement was seen even in cases where the clot was not, involved the lysis of microemboli, too small to be picked up by imaging devices, particularly in patients where spontaneous recanalization of embolitic strokes occurs.

“Both subgroups, nonlacunar and lacunar strokes, were found to have had better clinical outcome after receiving r-tPA [recombinant tissue-type plasminogen activator],” Lahoti et al wrote.

“A prospective study to validate these results is needed and is being planned.”