静脉内与联合(静脉内和动脉内)溶栓治疗急性缺血性卒中的比较:一项经颅彩色编码多普勒超声引导的先导性研究

• 作 者: Sekoranja L. Loulidi J. Yilmaz H. R.F.Sztajzel 郭俊
• 机 构: Dr.Neurosonology Unit Department of Neurology,24,rue Micheli-du-Crest,1211 Geneva 14,Switzerland,
• 出 处: 世界核心医学期刊文摘(神经病学分册)
• 发表日期: 2006年12期
• 关键词: 急性缺血性卒中 彩色编码 血管再通 大脑中动脉闭塞 脑内出血 脑缺血 血管造影 预后良好 血流分级 临床观察指标

BACKGROUND AND PURPOSE-Determine feasibility and safety of intravenous(IV)versus combined(IV-IA [intra-arterial])thrombolysis guided by transcranial color-coded duplex sonography(TCCD).METHODS-Thirty-three patients eligible for IV thrombolysis,within 3 hours of onset of symptoms,with occlusion in middle cerebral artery territory(TCCD monitoring,thrombolysis in brain ischemia [TIBI] flow grade [0-3]),underwent IV thrombolysis(tissue plasminogen activator,0.9 mg/kg).In case of recanalization(modification of TIBI score ≥1)after 30 minutes IV thrombolysis was continued over 1 hour;otherwise,it was discontinued,with subsequent IA thrombolysis.Recanalization was determined by TIBI(TCCD)and angiographically by thrombolysis in myocardial infarction(TIMI)flow grades.Clinical outcome measures were assessed at baseline,24 hours(NIHSS)and 3 months(modified Rankin Scale).RESULTS-In the IV group,10/17 patients(59%)with complete or partial recanalization after 30 minutes had a favorable outcome at 3 months(modified Rankin Scale 0 to 2).TIBI flow grades 3 to 5 after 30 minutes of IV thrombolysis predicted a good prognosis compared with TIBI grades 1to 2(P < 0.05).In the combined IV/IA therapy group(no recanalization after 30 minutes),9/16 patients(56%)had a favorable outcome at 3 months.One symptomatic intracerebral hemorrhage occurred in each group.CONCLUSIONS-Combined IV-IA versus IV thrombolysis guided by TCCD was feasible and safe.Recanalization after 30 minutes of IV thrombolysis led to a favorable outcome in 59%of the patients,provided TIBI flow grades were of 3 to 5.In the absence of early recanalization during IV thrombolysis,there was clinical benefit to proceed to IA therapy for a significative proportion of patients(56%).

BACKGROUND AND PURPOSE-Determine feasibility and safety of intravenous (IV) versus combined (IV-IA [intra-arterial]) thrombolysis guided by transcranial color-coded duplex sonography (TCCD) .METHODS-Thirty-three patients eligible for IV thrombolysis, within 3 hours of onset of symptoms, with occlusion in middle cerebral artery territory (TCCD monitoring, thrombolysis in brain ischemia [TIBI] flow grade [0-3]), underwent IV thrombolysis (tissue plasminogen activator, 0.9 mg / kg) of was recurred, with subsequent IA thrombolysis. Removalization was determined by TIBI (TCCD) and angiographically by thrombolysis in myocardial infarction (TIMI) flow grades. Clinical outcome measures were assessed at baseline, 24 hours (NIHSS) and 3 months (modified Rankin Scale) .RESULTS-In the IV group, 10 of 17 patients (59%) with complete or partial recanalization after 30 minutes had a favorable outcome at 3 months (modified Rankin Scale 0 to 2). TIBI flow grades 3 to 5 after 30 minutes of IV thrombolysis predicted a good prognosis compared with TIBI grades 1 to 2 (P <0.05) .In the combined IV / IA therapy group (no recanalization after 30 minutes), 9 of 16 patients (56%) had a favorable outcome at 3 months. One symptomatic intracerebral hemorrhage occurred in each group. CONCLUSIONS-Combined IV-IA versus IV thrombolysis guided by TCCD was feasible and safe. minutes of IV thrombolysis led to a favorable outcome in 59% of the patients, provided TIBI flow grades were of 3 to 5. In the absence of early recanalization during IV thrombolysis, there was clinical benefit to proceed to IA therapy for a significative proportion of patients (56%).