Combined intravenous and intra-arterial thrombolysis in patients with acute ischemic stroke

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Author:
FU Rui(Department of Neurology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China)
ZHAO Xing-hui(Department of Neurology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China)
HUANG Dong(Department of Neurology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China)
ZHA NG Tong(Department of Neurology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China)
DAI Wei(Department of Neurology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China)
HE Mao-lin(Department of Neurology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China)
Journal Title:
Chinese Journal of Neuromedicine
Issue:
Volume 10, Issue 11, 2011
DOI:
10.3760/cma.j.issn.1671-8925.2011.11.003
Key Word:
Ischemic stroke;Thrombolytic therapy;Combined intravenous and intra-arterial thrombolysis;Recanalization rate

Abstract: Objective To evaluate the efficacy and safety of combined intravenous(Ⅳ)and intra-arterial(IA)thrombolysis in patients with acute ischemic stroke.Methods A prospective and open-label trial was performed on 40 patients with acute ischemic stroke in the carotid artery system within 3 hours of symptom onset,admitted to our hospital from May 2005 to February 2009; these patients were treated with recombinant tissue plasminogen activator(rt-PA)by a combined Ⅳ and IA thrombolysis approach.The percentage of favorable prognosis,incidence of symptomatic intraeranial haemorrhage(SICH)and fatality rate in these patients were compared with those research results from foreigners having large samples.Results According to the results of DSA,recanalization rate (grade-2 or-3 in the Thrombolysis in Cerebral Infarction[TICI]scale)after Ⅳ thrombolysis was 25%(10/40),rate of serious cerebrovascular stenosis was 7.5%(3/40),including 2 patients with stenosis of the internal carotid artery(ICA)and 1 with stenosis of the middle cerebral artery(MCA),and rate of vascular occlusion was 67.5%(27/40),including 9 patients with ICA occlusion and 18 with MCA occlusion.Twenty-four patients adopted combined Ⅳ and IA thrombolysis approach after 180-390 min(mean[304±61]min)of stroke onset,and their recanalization rate was 79.2%(19/24).Re-infarction rate was 7.5%(3/40).Three months after the thrombolysis,percentage of good functional outcomes(modified Rankin Scale[mRS])scores:0-2)was 60%(24/40),which had significant differences as compared with that with NINDS placebo treatment(27.2%[85/312],P<0.05); percentage of good functional outcomes(NIHSS score ≤ 1)was 52.5%(21/40),which had significant differences as compared with that of groups with NINDS rt-PA treatment(31%[97/312]),NINDS placebo treatment(20%[62/312])and interventionalmanagement of stroke(IMS,27.5%[22/80]),P<0.05); SICH was noted in 2.5%(1/40)and fatality in 10%(4/40)accepted thrombolysis,and no significant differences were noted as compared with those in groups with NINDS rt-PA treatment,NINDS placebo treatment,emergency management of stroke EMS and IMS (P>0.05).Conclusion Combined Ⅳ and IA thrombolysis is an effective and safe new method in treating patients with acute ischemic stroke by providing good vascular recanalization rate and good clinical outcomes.

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