A COMPARISON OF INTRAARTERIAL AND INTRAVENOUS TISSUE-TYPE PLASMINOGEN-ACTIVATOR ON AUTOLOGOUS ARTERIAL EMBOLI IN THE CEREBRAL-CIRCULATION OF RABBITS
A COMPARISON OF INTRAARTERIAL AND INTRAVENOUS TISSUE-TYPE PLASMINOGEN-ACTIVATOR ON AUTOLOGOUS ARTERIAL EMBOLI IN THE CEREBRAL-CIRCULATION OF RABBITS
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DOI：
10.1161/01.str.25.3.651
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发表时间：
1994-03-01
期刊：
影响因子：
8.3
通讯作者：
ZABRAMSKI, JM
中科院分区：
文献类型：
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作者：
HAMILTON, MG;LEE, JS;ZABRAMSKI, JM
背景和目的溶栓治疗栓塞性卒中的疗效一直是实验和临床研究的课题。本研究的目的是比较两种不同给药方式（动脉内和静脉内）的组织型纤溶酶原激活剂（TPA）在兔实验性栓塞性卒中后30分钟的疗效，在减少缺血脑体积方面。通过将自体动脉血栓碎片注射到一个颈内动脉中来模拟兔的栓塞性中风。栓塞后30分钟，用2 mg/kg动脉内TPA、2 mg/kg静脉内TPA或生理盐水对家兔进行盲法处理（所有n=10）。栓塞后6小时处死兔。结果TPA能明显缩小缺血性脑损伤的体积，并能明显减轻缺血性脑损伤的程度（P < .0001）：对照组动物持续缺血性损伤至20.1 +/- 4.6%（平均值+/- SD），而动脉内TPA治疗的动物为4.6 +/- 4.1%，静脉内TPA治疗的动物为3.4 +/- 2.6%。动脉内和静脉内TPA治疗之间的差异是不显着的（P = .786）。结论在这个兔模型的栓塞性中风，TPA的管理在30分钟内导致缺血性损伤的数量急剧减少，具有相同的效力为两种模式的管理。这些结果支持静脉内TPA治疗急性栓塞性卒中，因为静脉内治疗可以在临床环境中快速建立。
Background and Purpose The efficacy of thrombolytic therapy for treatment of embolic stroke has been a subject of both experimental and clinical examination. The aim of this study was to compare the efficacy, in regard to reduction of volume of ischemic brain, of two different modes of administration tie, intra-arterial and intravenous) of tissue-type plasminogen activator (TPA) given 30 minutes after experimental embolic stroke in rabbits.Methods A randomized, blinded, controlled experimental trial was undertaken. Embolic stroke was simulated in rabbits by injecting fragments of autologous arterial thrombus into one internal carotid artery. Thirty minutes after embolization, the rabbits were blindly treated with 2 mg/kg intra-arterial TPA, 2 mg/kg intravenous TPA, or saline (all n=10). Six hours after embolization the rabbits were killed. The brains were perfused with triphenyltetrazolium chloride and cut into 0.5cm-thick coronal sections, and the areas of ischemia were measured.Results Administration of TPA resulted in a significant reduction in the volume of ischemic cerebral injury (P < .0001): control animals sustained ischemic injury to 20.1 +/- 4.6% (mean +/- SD) of total brain compared with 4.6 +/- 4.1% for animals treated with intra-arterial TPA and 3.4 +/- 2.6% for those treated with intravenous TPA. The difference between intraarterial and intravenous TPA treatment was not significant (P = .786).Conclusions In this rabbit model of embolic stroke, administration of TPA within 30 minutes resulted in a dramatic reduction in the amount of ischemic injury, with equal efficacy for the two modes of administration. These results favor the treatment of acute embolic stroke with intravenous TPA, given the rapidity with which intravenous therapy can be established in the clinical setting.