INTRAVENOUS RECOMBINANT TISSUE PLASMINOGEN-ACTIVATOR IN ACUTE CAROTID-ARTERY TERRITORY STROKE
INTRAVENOUS RECOMBINANT TISSUE PLASMINOGEN-ACTIVATOR IN ACUTE CAROTID-ARTERY TERRITORY STROKE
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DOI：
10.1212/wnl.42.5.976
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发表时间：
1992-05-01
期刊：
影响因子：
9.9
通讯作者：
YAMADORI, A
中科院分区：
文献类型：
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作者：
MORI, E;YONEDA, Y;YAMADORI, A
为了确定静脉注射重组组织纤溶酶原激活剂（rt-PA）对血管和神经系统结局的影响，我们在一项随机、双盲、安慰剂对照研究中纳入了31例症状发作6小时内的急性颈动脉区域缺血性卒中患者。我们给随机分配到三组的患者静脉注射rt-PA（剂量为20或30百万国际单位[MIU]的度替普酶）或安慰剂60分钟。基线和输注后血管造影片之间的比较显示，接受30 MIU rt-PA治疗的患者中有50%（5/10）发生完全或部分再灌注，接受20 MIU rt-PA治疗的患者中有44%（4/9）发生完全或部分再灌注，对照组为17%（2/12）。在大脑中动脉闭塞的患者中，30-MIU组的71%（5/7），20-MIU组的67%（4/6）和对照组的13%（1/8）发生再灌注。与安慰剂治疗组相比，接受30 MIU rt-PA治疗的患者表现出明显的早期和更好的临床改善（通过神经功能量表测量）。各组各有1例患者发生脑实质出血，治疗组间无临床意义的出血性梗死的频率相当。任何组均未发生重大全身并发症。这些结果支持卒中发作后立即静脉输注rt-PA在快速溶栓和神经功能恢复方面的疗效;它可能对大脑中动脉血栓栓塞性闭塞患者特别有价值。
To determine the effect of intravenous recombinant tissue plasminogen activator (rt-PA) on vascular and neurologic outcomes, we enrolled 31 patients with acute carotid artery-territory ischemic stroke within 6 hours from symptom onset in a randomized, double-blind, placebo-controlled study. We gave either rt-PA (duteplase at the dose of 20 or 30 mega-international units [MIU]) or placebo intravenously for 60 minutes in patients randomly assigned to the three groups. A comparison between the baseline and postinfusion angiograms showed that complete or partial reperfusion occurred in 50% (5/10) of patients treated with 30 MIU rt-PA, 44% (4/9) of those treated with 20 MIU rt-PA, and 17% (2/12) in the control group. In patients with middle cerebral artery occlusions, reperfusion occurred in 71% (5/7) of the 30-MIU group, in 67% (4/6) of the 20-MIU group, and in 13% (1/8) of the control group. Patients treated with 30 MIU rt-PA showed a significantly early and better clinical improvement, as measured by the neurologic scale, than did those treated with placebo. Parenchymal hemorrhage occurred in one patient in each group, and frequency of clinically insignificant hemorrhagic infarction was comparable among the treatment groups. No major systemic complications occurred in any group. These results support the efficacy of intravenous infusion of rt-PA soon after the onset of stroke in producing rapid thrombolysis and neurologic recovery; it may be of particular value in patients with thromboembolic occlusion in the middle cerebral artery.