BACKGROUND Intravenous thrombolysis (IVT) for lacunar stroke (LS) is debated, as the underlying pathophysiological mechanism may not be thrombogenic. AIMS To investigate outcomes after IVT in LS in the SITS International Stroke Thrombolysis Register and perform a meta-analysis. METHODS LS was identified by both baseline NIHSS-subscores and discharge ICD-10 codes, and contrasted by IVT to non-IVT treated. IVT patients were predominantly from Europe, non-IVT patients predominantly from South America and Asia. Outcome measurements were functional independence (modified Rankin Scale [mRS] score ≤2), excellent outcome (mRS ≤ 1), and mortality at three months. Matched-control comparisons of symptomatic intracerebral hemorrhage (SICH) between IVT-treated LS and IVT-treated non-LS patients were performed. Additionally, we performed a meta-analysis. RESULTS Median age for IVT-treated LS patients (n = 4610) was 66 years vs. 64 years and NIHSS score was 6 vs. 3, compared to non-IVT-treated LS (n = 1221). Univariate outcomes did not differ; however, IVT-treated LS patients had higher adjusted odds ratios (aOR) for functional independence (aOR = 1.65, 95% CI = 1.28-2.13) but similar mortality at three months (aOR = 0.57, 0.29-1.13) than non-IVT-LS. Propensity-score matched analysis showed that IVT-treated LS patients had a 7.1% higher chance of functional independency than non-IVT LS patients (p < 0.001). IVT-treated LS patients had lower odds for SICH (aOR = 0.33, 0.19-0.58 per SITS, aOR = 0.40, 0.27-0.57 per ECASS-2) than matched non-LS controls, which was mirrored in the meta-analysis. CONCLUSIONS Our adjusted results show that IVT treatment in LS patients was associated with better functional outcome than non-IVT-treated LS and less SICH than IVT-treated non-LS patients.

中文翻译：

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急性腔隙性脑卒中患者静脉溶栓后的结果：一项基于SITS国际注册和荟萃分析的观察性研究。

背景技术针对腔隙性脑卒中（LS）的静脉溶栓治疗（IVT）一直存在争议，因为其潜在的病理生理机制可能不是血栓形成的原因。目的调查SITS国际卒中溶栓登记册中LS IVT后的结局并进行荟萃分析。方法LS是通过基线NIHSS子评分和ICD-10排放代码来识别的，并通过IVT与未经IVT治疗的患者进行对比。IVT患者主要来自欧洲，非IVT患者主要来自南美和亚洲。结果测量为功能独立性（改良的Rankin量表[mRS]得分≤2），出色的预后（mRS≤1）和三个月时的死亡率。在IVT治疗的LS患者和IVT治疗的非LS患者之间进行有症状的脑出血（SICH）的对照对照比较。此外，我们进行了荟萃分析。结果与非IVT治疗的LS（n = 1221）相比，IVT治疗的LS患者（n = 4610）的中位年龄为66岁vs. 64岁，NIHSS评分为6 vs. 3。单变量结果无差异。然而，接受IVT治疗的LS患者的功能独立性调整后优势比（aOR）较高（aOR = 1.65，95％CI = 1.28-2.13），但三个月时的死亡率（aOR = 0.57，0.29-1.13）与非IVT相似-LS。倾向得分匹配分析显示，IVT治疗的LS患者功能独立性的机会比非IVT LS患者高7.1％（p <0.001）。IVT治疗的LS患者发生SICH的几率比匹配的非LS对照低（aOR = 0.33，每个SITS为0.19-0.58，aOR = 0.40，0.27-0.57，根据ECASS-2），这在荟萃分析中得到了反映。