Intravenous Thrombolysis Prevents Neurological Deterioration in Patients with Acute Pontine Infarction

Overview

Journal Front Neurol

Date 2025 Feb 6

PMID 39911452

Authors

Zhenxiao Chai

Weili Chen

Yichan Ye

Mengwan Song

Lingling Lin

Dongdong Lin

Xuerong Huang

Lifen Chi

Ruyue Huang

Affiliations

Soon will be listed here.

Abstract

Objectives: Neurological deterioration (ND) is common after acute isolated pontine infarction, and no evidence-based treatment is available to prevent this. We determined whether intravenous thrombolysis (IVT) with tissue plasminogen activator soon after pontine infarction prevents ND.

Methods: We retrospectively enrolled consecutive patients admitted to our hospital within 4.5 h after the onset of isolated pontine infarction identified using diffusion-weighted imaging. Patients were divided into the IVT and non-IVT groups. ND was defined as any ≥2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score between the maximal and initial neurological deficits during hospitalization. Patients' clinical characteristics, laboratory findings, and outcomes were analyzed to determine the efficacy and safety of IVT.

Results: Of 211 study patients (median age, 67 years [interquartile range, 57-75 years]; 132 [62.6%] men), 74 received IVT; 137 patients did not receive IVT, but accepted other antithrombotic therapies, including antiplatelet or anticoagulant drugs. The NIHSS score on admission was higher in the IVT group than in the non-IVT group (7 vs. 4, = 0.000), but that at discharge was similar in both groups (4 vs. 5, = 0.975). ND occurred in 17 (23.0%) and 51 (37.2%) patients in the IVT and non-IVT groups, respectively ( = 0.044). Multiple logistic regression analysis identified IVT (odds ratio, 1.509; 95% confidence interval, 1.250-3.034) as an independent factor for preventing ND. The incidence of intracranial hemorrhagic transformation ( = 0.351) and major visceral organ hemorrhage ( = 0.122) was similar in both groups.

Conclusions: IVT may prevent early ND after acute pontine infarction without increasing intracranial hemorrhagic transformation, possibly by decreasing the total thrombotic burden.

References

Oh S, Bang O, Chung C, Lee K, Chang W, Kim G . Topographic location of acute pontine infarction is associated with the development of progressive motor deficits. Stroke. 2012; 43(3):708-13. DOI: 10.1161/STROKEAHA.111.632307. View

Vynckier J, Maamari B, Grunder L, Goeldlin M, Meinel T, Kaesmacher J . Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome. Neurology. 2021; 97(14):e1437-e1446. DOI: 10.1212/WNL.0000000000012661. View

Aoki J, Iguchi Y, Kimura K, Shibazaki K, Iwanaga T, Sakai K . Diameter of the basilar artery may be associated with neurological deterioration in acute pontine infarction. Eur Neurol. 2010; 63(4):221-6. DOI: 10.1159/000279619. View

Al Qawasmeh M, Aldabbour B, Momani A, Obiedat D, Alhayek K, Kofahi R . Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke. Stroke Res Treat. 2020; 2020:1920583. PMC: 7292978. DOI: 10.1155/2020/1920583. View

Vemmos K, Spengos K, Tsivgoulis G, Manios E, Zis V, Vassilopoulos D . Aetiopathogenesis and long-term outcome of isolated pontine infarcts. J Neurol. 2005; 252(2):212-7. DOI: 10.1007/s00415-005-0639-9. View

Huang R, Zhang X, Chen W, Lin J, Chai Z, Yi X . Stroke Subtypes and Topographic Locations Associated with Neurological Deterioration in Acute Isolated Pontine Infarction. J Stroke Cerebrovasc Dis. 2015; 25(1):206-13. DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.019. View

Siegler J, Martin-Schild S . Early Neurological Deterioration (END) after stroke: the END depends on the definition. Int J Stroke. 2011; 6(3):211-2. DOI: 10.1111/j.1747-4949.2011.00596.x. View

Saia V, Pantoni L . Progressive stroke in pontine infarction. Acta Neurol Scand. 2009; 120(4):213-5. DOI: 10.1111/j.1600-0404.2009.01161.x. View

Seners P, Turc G, Oppenheim C, Baron J . Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications. J Neurol Neurosurg Psychiatry. 2014; 86(1):87-94. DOI: 10.1136/jnnp-2014-308327. View

10.

Bassetti C, Bogousslavsky J, Barth A, Regli F . Isolated infarcts of the pons. Neurology. 1996; 46(1):165-75. DOI: 10.1212/wnl.46.1.165. View

11.

Silverstein A . ACUTE INFARCTIONS OF THE BRAIN STEM IN THE DISTRIBUTION OF THE BASILAR ARTERY. Confin Neurol. 1964; 24:37-61. View

12.

Gokcal E, Niftaliyev E, Baran G, Deniz C, Asil T . Progressive deficit in isolated pontine infarction: the association with etiological subtype, lesion topography and outcome. Acta Neurol Belg. 2017; 117(3):649-654. DOI: 10.1007/s13760-017-0827-2. View

13.

Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K . Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American.... Stroke. 2019; 50(12):e344-e418. DOI: 10.1161/STR.0000000000000211. View

14.

Kumral E, Bayulkem G, Evyapan D . Clinical spectrum of pontine infarction. Clinical-MRI correlations. J Neurol. 2003; 249(12):1659-70. DOI: 10.1007/s00415-002-0879-x. View

15.

Schonewille W, Wijman C, Michel P, Rueckert C, Weimar C, Mattle H . Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol. 2009; 8(8):724-30. DOI: 10.1016/S1474-4422(09)70173-5. View

16.

Kim J, Lee J, Im J, Lee M . Syndromes of pontine base infarction. A clinical-radiological correlation study. Stroke. 1995; 26(6):950-5. DOI: 10.1161/01.str.26.6.950. View

17.

Ha S, Kim B, Ryu J, Bae J, Kim J . Basilar Artery Tortuosity May Be Associated with Early Neurological Deterioration in Patients with Pontine Infarction. Cerebrovasc Dis. 2022; 51(5):594-599. DOI: 10.1159/000522142. View

18.

Seners P, Hurford R, Tisserand M, Turc G, Legrand L, Naggara O . Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension?. Stroke. 2016; 48(2):348-352. DOI: 10.1161/STROKEAHA.116.015414. View

19.

Honig A, Percy J, Sepehry A, Gomez A, Field T, Benavente O . Hemorrhagic Transformation in Acute Ischemic Stroke: A Quantitative Systematic Review. J Clin Med. 2022; 11(5). PMC: 8910828. DOI: 10.3390/jcm11051162. View

20.

Liu Y, Peng H, Wang J, He L, Xu J, Zheng M . Risk factors for early neurological deterioration in acute isolated pontine infarction without any causative artery stenosis. BMC Neurol. 2022; 22(1):332. PMC: 9440546. DOI: 10.1186/s12883-022-02861-5. View