Direct Percutaneous Transluminal Angioplasty for Acute Middle Cerebral Artery Trunk Occlusion: An Alternative Option to Intra-arterial Thrombolysis
Direct Percutaneous Transluminal Angioplasty for Acute Middle Cerebral Artery Trunk Occlusion: An Alternative Option to Intra-arterial Thrombolysis
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直接经皮腔内血管成形术治疗急性大脑中动脉干闭塞：动脉内溶栓的替代选择
DOI：
10.1161/01.str.0000038985.26269.f2
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
S. Wakisaka
中科院分区：
文献类型：
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作者：
S. Nakano;T. Iseda;T. Yoneyama;H. Kawano;S. Wakisaka
背景和目的-本研究旨在评价直接经皮腔内血管成形术（PTA）治疗急性大脑中动脉（MCA）主干闭塞患者的安全性和有效性。方法：在过去的9年中，共有70例急性MCA主干闭塞患者接受了动脉内再灌注治疗。在过去5年中，34例患者接受了直接PTA治疗，如果需要远端栓塞，则增加了后续溶栓治疗。另36例患者，主要是在前4年，单独溶栓治疗，并作为对照。采用美国国立卫生研究院卒中量表评分评估治疗前神经系统状态。使用改良兰金量表（mRS）评估90天时的临床结局。结果：两组治疗前国立卫生研究院卒中量表评分和缺血持续时间无显著差异。部分或完全再通率PTA组为91.2%，单纯溶栓组为63.9%（P <0.01）。PTA组中伴有神经功能恶化的大脑实质血肿的发生率为2.9%，而单纯溶栓组为19.4%（P =0.03）。尽管直接PTA并未改善有利结局率（mRS评分0或1;单独溶栓组为41.7%，PTA组为52.9%;P =0.48），但PTA组（73.5%）的独立性结局（mRS评分0、1、2）显著优于单独溶栓组（50.0%;P =0.04）。结论-虽然由于开放性试验，无法得出关于这2种治疗方法的比较优势的明确结论，但直接PTA可能是急性MCA主干闭塞动脉内溶栓的有效替代选择。
Background and Purpose— The purpose of this study was to evaluate the safety and efficacy of direct percutaneous transluminal angioplasty (PTA) for patients with acute middle cerebral artery (MCA) trunk occlusion. Methods— Over the past 9 years, a total of 70 patients with acute MCA trunk occlusion were treated with intra-arterial reperfusion therapy. In the last 5 years, 34 patients were treated with direct PTA, and subsequent thrombolytic therapy was added if necessary for distal embolization. The other 36 patients, mainly in the first 4 years, were treated with thrombolytic therapy alone and were used as controls. Pretherapeutic neurological status was evaluated with National Institutes of Health Stroke Scale scores. The modified Rankin Scale (mRS) was used to assess clinical outcome at 90 days. Results— There were no significant differences in pretherapeutic National Institutes of Health Stroke Scale score and duration of ischemia between the 2 groups. The rate of partial or complete recanalization in the PTA group was 91.2%, whereas that in the thrombolysis-alone group was 63.9% (P <0.01). The incidence of large parenchymal hematoma with neurological deterioration in the PTA group was 2.9%, while that in the thrombolysis-alone group was 19.4% (P =0.03). Although direct PTA did not improve the rate of favorable outcome (mRS score 0 or 1; 41.7% for the thrombolysis-alone group versus 52.9% for the PTA group;P =0.48), outcome in terms of independence (mRS score 0, 1, 2) was significantly better in the PTA group (73.5%) than in the thrombolysis-alone group (50.0%;P =0.04). Conclusions— Although definitive conclusions on the comparative merits of these 2 therapies cannot be drawn because of an open trial, direct PTA may be an effective alternative option to intra-arterial thrombolysis for acute MCA trunk occlusion.
影响因子：
8.3
作者：
HACKE, W;ZEUMER, H;DELZOPPO, GJ
通讯作者：
DELZOPPO, GJ
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