الفهرس 
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Abstract
Lacunar infarcts are small subcortical infarcts mainly located in the basal ganglia, internal capsule, thalamus, corona radiata and brainstem. About 25% of all ischemic strokes are lacunar in type. These small lesions (<cm in 2 diameter, <cm in some definitions) affect the white matter and deep gray 1.5 matter of the cerebral hemispheres and brainstem and are associated with several discrete neurological syndromes.
Lacunar infarcts are considered to be caused by progressive lipohyalinosis and atherosclerosis of deep penetrating arteries contrast with cardioembolic or large-artery atherosclerotic stroke, where embolized thrombus material is abruptly occluding a cerebral vessel.
Intravenous thrombolysis with alteplase became the first evidence-based short-term treatment for improving outcomes after AIS over 20 years ago. Since then, this treatment has been confirmed to be effective within 4.5 hours of stroke onset in randomized controlled trials and through extensive experience across the globe. Over time, it has also become clear that patients with some of the exclusion criteria from the original trials can safely receive thrombolysis.
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is established in acute ischemic stroke. Little is known, however, about its efficacy in different stroke subtypes. The aim of this study was to describe the outcome in patients with acute lacunar stroke who received IVT to determine the efficacy of IVT in lacunar stroke.
In this study we analyzed 247 patients presented with acute lacunar stroke identified as best as possible according to imaging and etiological criteria. Of these; 58 patients received IV thrombolytic therapy within 4.5 hours after onset, while 189 patients didn’t receive thrombolysis.
In comparison to non-thrombolysed patients, acute lacunar stroke patients treated with rtPA were more severely affected on admission with 7 as median NIHSS on admission compared to 5 in non-thrombolysed patients.
When comparing both groups regarding NIHSS and mRS upon discharge, there was no statistically significant difference between thrombolysed patients & non-thrombolysed patients as the median NIHSS upon discharge was 2 in thrombolysed patients with IQR (1-5) to 3 in non-thrombolysed patients with IQR (2-6). While there was a highly statistically significant difference in mRS upon discharge between the two groups as demonstrated by the higher median in non-thrombolysed patients 2 (1 – 3) compared to thrombolysed patients 0 (0 – 2).
When comparing the two groups regarding NIHSS and mRS after 3 months, there was a high statistically significant difference with better NIHSS in thrombolysed patients (2 with IQR of 0-4) compared to non-thrombolysed patients as the median NIHSS after 3 months was (3 with IQR 2-6).
When comparing mean difference between both groups regarding severity of symptoms at the different time intervals using NIHSS and mRS scores; it was found that there was a high statistically significant difference in NIHSS mean difference as described by a median of (-4 (-6 – -2)) in thrombolysed patients compared to (-1 (-2 – 0)) in non-thrombolysed patients indicating better improvement in thrombolysed patients. It was also found that there was a statistically significant difference in mean difference of mRS as reported by a median of 0 in thrombolysed patients compared to 1 in non-thrombolysed patients. These results concluded that thrombolysed patients showed better improvement and had less physical disability on the long run.
We found that hemorrhagic transformation and brain edema occurred only in thrombolysed patients as complications of rtPA; which indicates that although IV thrombolysis might be an effective treatment of acute lacunar stroke it might lead to hazardous outcome.
In whole, we came to concluding that according to our findings, IV thrombolysis is beneficial in patients presented with acute ischemic lacunar stroke, and thus they should not be treated differently from other stroke subtypes.