INTRA-ARTERIAL THROMBOLYTIC THERAPY IMPROVES OUTCOME IN PATIENTS WITH ACUTE VERTEBROBASILAR OCCLUSIVE DISEASE
INTRA-ARTERIAL THROMBOLYTIC THERAPY IMPROVES OUTCOME IN PATIENTS WITH ACUTE VERTEBROBASILAR OCCLUSIVE DISEASE
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DOI：
10.1161/01.str.19.10.1216
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发表时间：
1988-10-01
期刊：
影响因子：
8.3
通讯作者：
DELZOPPO, GJ
中科院分区：
文献类型：
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作者：
HACKE, W;ZEUMER, H;DELZOPPO, GJ
在这项回顾性分析中，我们报告了我们在65例连续患者中的治疗经验，这些患者具有严重脑干缺血的临床体征，血管造影显示血栓性椎基底动脉闭塞，接受局部动脉内溶栓治疗（尿激酶或链激酶）（43例患者）或常规治疗（抗血小板药物或抗凝剂）（22例患者）。我们分析了脑动脉闭塞模式、治疗后动脉再通、有利/不利结局和生存/死亡的临床分类的数据。在亚组分析中，接受溶栓治疗的患者的再通与临床结局显著相关; 43例患者中有19例血管造影显示再通，而24例患者的闭塞持续存在。所有未再通的患者均死亡，但19例显示再通的患者中有14例存活（p = 0.000007），10例具有良好的临床结局。接受常规治疗的22名患者中只有3名存活，均具有中度临床缺陷。当我们比较治疗组时，发现结局质量（p = 0.017）和生存率（p = 0.0005）的高度显著差异取决于建立再通。我们的数据支持椎基底动脉闭塞技术上成功的溶栓与有益的临床结局相关的概念。
In this retrospective analysis we report our treatment experience in 65 consecutive patients with clinical signs of severe brainstem ischemia with angiographically demonstrated thrombotic vertebrobasilar artery occlusions who received either local intra-arterial thrombolytic therapy (urokinase or streptokinase) (43 patients) or conventional therapy (antiplatelet agents or anticoagulants) (22 patients). We analyzed the data with respect to cerebral artery occlusion patterns, posttreatment arterial recanalization, and the clinical categories of favorable/unfavorable outcome and survival/death. In subgroup analyses, recanalization in patients who received thrombolytic therapy correlated significantly with clinical outcome; in 19 of 43 patients, recanalization was demonstrated angiographically, while in 24 patients the occlusion persisted. All patients without recanalization died, but 14 of the 19 patients displaying recanalization survived (p = 0.000007), 10 with a favorable clinical outcome. Only three of the 22 patients who received conventional therapy survived, all with a moderate clinical deficit. When we compared the treatment groups, highly significant differences in both outcome quality (p = 0.017) and survival (p = 0.0005) were found to depend on establishing recanalization. Our data support the concept that technically successful thrombolysis of vertebrobasilar artery occlusions is associated with beneficial clinical outcome.