Intravenous Tissue Plasminogen Activator Thrombolysis in Patients without Major Arterial Occlusion Seems to Be Safe and Effective

BACKGROUND: It is not clear whether tissue plasminogen activator (t-PA) thrombolysis in patients without major arterial occlusion is effective or safe. METHODS: Consecutive anterior circulation stroke patients treated with t-PA within 3 h of onset were studied. The patients were divided into three groups according to magnetic resonance angiography findings before t-PA infusion: ICA group, ICA occlusion; MCA group, M1 and M2 occlusion, and no occlusion group. Clinical characteristics, the presence of hemorrhagic transformation on T₂* at 24 h after t-PA thrombolysis, and outcome at 3 months were compared among the three groups. RESULTS: 112 patients were enrolled. The no occlusion group had 21 (18.8%) patients, the ICA group had 29 (25.9%), and the MCA group had 62 (55.4%). The frequency of hemorrhagic transformation was only 4.8% in the no occlusion group (31.0% for the ICA group, and 48.4% for the MCA group, p = 0.0012). At 3 months after t-PA therapy, 61.5% of the no occlusion group had a favorable outcome (modified Rankin score 0-1), which was the highest among the three groups (15.0% for the ICA group, and 41.5% for the MCA group, p = 0.0203). CONCLUSION: Intravenous t-PA therapy in acute stroke patients without major artery occlusion seems to be safe and effective.