Efficacy of intravenous thrombolysis in treating cortical and lacunar strokes: analysis from the Qatar Stroke Registry in a multi-ethnic population.

Objective: Intravenous thrombolysis is an effective method in treating acute ischaemic stroke, with several studies reporting improved outcomes and reduced mortality rates. However, there are limited data on whether thrombolysis is effective in treating different ischaemic stroke subtypes in the Middle East and North African region. Methods: Data of cortical and lacunar patients who received intravenous thrombolysis from the Qatar Stroke Registry were retrospectively analysed from April 2014 to January 2025. Patients were matched 1:2 for age and admission National Institute of Health Stroke Scale (NIHSS). Results: Patients with cortical stroke who received recombinant tissue-type plasminogen activator (rt-PA) had a significantly lower proportion of a poor clinical outcome at 90 days (modified Rankin Scale (mRS) score of 3-6; 41.5% vs 50.5%, p=0.002), significantly lower NIHSS score at discharge (NIHSS score >10: 23.0% vs 33.9%, p<0.001), significantly lower proportion of mortality at 90 days (4.7% vs 8.2%, p=0.02) and significantly shorter length of stay (5.2 days vs 6.0 days, p=0.01) compared with controls. In terms of outcomes for patients with lacunar stroke, there were no significant differences compared with controls for their mRS score at 90 days (p=0.054), NIHSS score at discharge (p=0.21), mortality at 90 days (p=0.67) and length of stay (p=0.34). A multivariate conditional logistic regression model revealed that high admission NIHSS score (>10) was a significant predictor of a poor functional outcome at 90 days for cortical stroke post rt-PA (p<0.001), whereas for lacunar stroke, both high admission NIHSS score (>10) and symptom onset of >3 hours were identified as significant predictors of a poor functional outcome at 90 days post rt-PA (p=0.01 for both). History of diabetes mellitus and hypertension were also significant predictors of poor clinical outcome at 90 days, but this was only observed for cortical stroke (p<0.001 and p=0.003). Conclusion: In this study, intravenous thrombolysis yielded significant clinical outcomes for patients with cortical stroke but not patients with lacunar stroke.