Fibrinolytic therapy for acute embolic stroke: intravenous, intracarotid, and intra-arterial local approaches.
Fibrinolytic therapy for acute embolic stroke: intravenous, intracarotid, and intra-arterial local approaches.
复制标题
急性栓塞性中风的纤溶治疗：静脉内、颈动脉内和动脉内局部方法。
作者：
Osamu Sasaki;Shigekazu Takeuchi;T. Koike;T. Koizumi;Ryuichi Tanaka
为了阐明动脉内局部输注大剂量纤溶剂治疗急性栓塞性卒中的疗效和局限性，我们分析了44例患者的结果，并与51例接受颈动脉内（18例）或静脉内（33例）输注治疗的患者进行了比较。10兆单位的重组组织型纤溶酶原激活剂或24 × 10（4）IU的尿激酶通过微导管注入栓塞物中或栓塞物近端20分钟。当未实现动脉再通时，进行第二次或第三次输注。局部灌注后即刻的完全和部分再通率分别为52%和32%。在大脑中动脉和基底动脉闭塞中高，而在颈内动脉闭塞中低（分别为69%、78%和20%）。在我们的使用中，组织型纤溶酶原激活剂和尿激酶在恢复血流方面没有差异。大脑中动脉闭塞患者从发病到再通的平均时间为4.8小时，基底动脉闭塞患者为5.8小时。梗死范围缩小，完全再通患者预后良好。24小时内出血性梗死的发生率为22%，仅1例患者临床恶化。在颈动脉内灌注组（20 × 104 IU尿激酶30 min）中，只有2例患者显示部分再通，但临床症状没有改善。出血性脑梗死的发生率为28%。与局部输注组相比，该组和静脉输注组（尿激酶18 × 104 IU/d，持续1周）的结局较差，显示完全再通。这项初步研究似乎表明，动脉内局部纤溶治疗可能是急性栓塞性卒中的一种新策略。
To clarify the efficacy and limitations of the intra-arterial local infusion of a high-dose fibrinolytic agent for acute embolic stroke, we analyzed the results of 44 patients and compared them with those of 51 patients treated with intracarotid (18 patients) or intravenous (33 patients) infusion therapy. Ten megaunits of recombinant tissue plasminogen activator or 24 x 10(4) IU of urokinase were administered through a microcatheter placed into or proximal to an embolus for 20 minutes. When arterial recanalization was not achieved, a second or third infusion was performed. The rates of complete and partial recanalization just after the local infusion were 52 and 32%, respectively. They were high in middle cerebral and basilar artery occlusion and low in internal carotid artery occlusion (69, 78, and 20%, respectively). In our use, there was no difference between tissue plasminogen activator and urokinase in restoring blood flow. The mean time interval from onset to recanalization in patients with middle cerebral artery occlusion showing marked improvement was 4.8 hours, and it was 5.8 hours with basilar artery occlusion. The size of infarction was reduced, and the outcome was good in patients with complete recanalization achieved. The incidence of hemorrhagic infarction within 24 hours was 22%, and only one patient clinically deteriorated. In the intracarotid infusion group (20 x 10(4) IU of urokinase for 30 min), only two patients showed partial recanalization without clinical improvement. The incidence of hemorrhagic infarction was 28%. The outcome in this group and the intravenous infusion group (18 x 10(4) IU of urokinase a day for 1 wk) was poor compared with that in the local infusion group showing complete recanalization. This preliminary study appears to suggest that intra-arterial local fibrinolytic therapy could be a new strategy for acute embolic stroke.
影响因子：
8.3
作者：
HACKE, W;ZEUMER, H;DELZOPPO, GJ
通讯作者：
DELZOPPO, GJ
影响因子：
4.1
作者：
JONES, TH;MORAWETZ, RB;OJEMANN, RG
通讯作者：
OJEMANN, RG
脑血管疾病的溶栓治疗。
影响因子：
8.3
作者：
DelZoppo,GJ
通讯作者：
DelZoppo,GJ