ABSTRACT
Central retinal artery occlusion(CRAO), also known as eye stroke, always results in acute and painless visual loss. At present, conservative treatments, such as eye massage, lowering intraocular pressure and vasodilators have little effect on reducing visual loss. Intra-arterial thrombolysis(IAT)has significantly improved prognosis in patients with acute ischemic stroke, thus IAT has been gradually applied in the treatment of CRAO. IAT injects fibrinolytic drugs directly into the ophthalmic artery by a microcatheter, and dissolves the emboli that block the central retinal artery to restore the blood flow of the retina. Theoretically, IAT may be effective for CRAO as what has been found for stroke, but existing clinical studies exhibited inconsistent results. This paper summarizes the feasibility, efficacy, and safety of IAT treatment in CRAO. It will also analyze related factors that affect the prognosis, putting forward potential development directions and providing insights for the further clinical application of IAT.
ABSTRACT
Objective:To explore the short-term efficacy and safety of intra-arterial thrombolysis (IAT) in the treatment of retinal artery occlusion (RAO) with the assistance of the rescue green channel in the eye stroke center.Methods:A prospective, interventional, single-center study. Thirty-eight eyes from 38 RAO patients who received IAT treatment in Guangdong Provincial People’s Hospital were enrolled. All the patients were rescued via the green channel in our eye stroke center. Data from comprehensive ocular examinations including best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were collected. BCVA was measured with Snellen chart and converted to the logarithmic minimum angle of resolution (logMAR) unit for statistical analysis. RTVue XR OCTA was used to measure vascular densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary (RPC), and central retinal thickness (CRT). All RAO eyes attempted IAT treatment and 34 eyes were successful. Four eyes failed to complete IAT because of the occlusion of internal or common carotid arteries on the same side with the RAO eyes. Ocular examinations in post-operative 1-3 days were performed with the same devices and methods as those before surgery. Parameters measured before and after surgery include BCVA, VD of SCP, DCP, RPC, and CRT. Data of the green channel collected include the time intervals from onset of RAO to first presentation in local hospitals, and from onset of RAO to our eye stroke center. Comparisons of VD and CRT between the RAO eyes and contralateral healthy eyes were performed with independent samples Mann-Whitney U test; comparisons of VD and CRT in RAO eyes before and after IAT surgery were performed with paired samples Wilcoxon Rank Sum test. Results:Among the 34 RAO patients who had successful IAT surgery, 18 (52.9%, 18/34) were males and 16 (47.1%, 16/34) were females; the mean age was (51.0±12.9) years old. There were 30 and 4 eyes diagnosed as central RAO and branch RAO respectively. The logMAR BCVA before and after IAT surgery was 2.52±0.61 and 2.18±0.85 respectively, and the difference was statistically significant ( Z=-3.453, P=0.002). Before surgery, VD of SCP, DCP and RPC were significantly decreased and CRT was significantly increased in the affected eye compared with the contralateral healthy eyes, with the statistical significance ( P<0.001). Compared with those before surgery, the VD of SCP and DCP were significantly improved after surgery ( Z=-2.523, -2.427; P=0.010, 0.014), while there was no difference in VD of RPC and CRT ( Z=-1.448, -1.454; P=0.150, 0.159). The time interval between onset of RAO and first visit to the hospital was (6.56±6.73) hours; the time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early postoperative period and no cerebrocardiovascular events were observed later. he time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early postoperative period and no cerebrocardiovascular events were observed later. Conclusions:The short-term efficacy and safety of IAT in the treatment of RAO were satisfactory. The rescue time window might be prolonged.
ABSTRACT
Objective To investigate the clinical safety and efficacy of mechanical thrombectomy(MT) with Solitaire stent compared with the selective intra-arterial thrombolysis (IAT) in the treatment of acute cerebral infarction.Methods Totally 82 cases patients with severe acute ischemic stroke caused by middle cerebral artery stenosis from January 2014 to May 2016 in the stroke treatment center of the first people's Hospital in ZunYi city who were applied with the mechanical thrombectomy or the selective intra-arterial thrombolysis was included,and a comparative analysis was conducted on the mTICI rating to assess the interventional recanalization,the NIHSS score after the treatment,bleeding rate,and conditions of neurological functional recovery 90 days after operation.Results There were 42 cases applied with the mechanical thrombectomy (MT group),40 cases applied with the intra-arterial thrombolysis (IAT group).The total effective rate reached 85.70％ in the MT group and 62.50％ in the IAT group,the difference was significant (P ＜ 0.05).Compared with NIHSS score before operation,the score after the treatment showed a decreased trend.And the NIHSS score of MT group was better than that of the IAT group in a week after the treatment (P ＜ 0.05).The bleeding rate was lower in the MT group with statistically significant difference (P ＜ 0.05).Conclusion Compared to IAT,MT can provide broader time window,higher recanalization rate and better outcome in patients with severe acute ischemic stroke.
ABSTRACT
Objective To explore the value of dual-source dual-energy CT (DSDE-CT) in differentiating extravasation of iodine contrast agents from secondary hemorrhage after revascularization in acute ischemic stroke. Methods 46 acute ischemic stroke patients following intra-arterial thrombolysis were examined with DSDE-CT within 2 hours after the procedure. Simultaneous imaging at 80 kV/392 mA and 140 kV/196 mA was employed, and then mixed images, virtual unenhanced non-contrast images and iodine overlay maps were calculated. Mixed images alone, as conventional CT, and DUDE-CT interpretations were assessed separately by two radiologists and compared with follow-up CT. Results 6 of 34 patients were negative cases proven by CT without high density, and another 28 cases were proven positive cases with 3 cases of cerebral hemorrhage, 21 cases of contrast agent extravasation, and the remaining 4 cases of combined cerebral hemorrhage and contrast agent extravasation. The sensibility, specificity, positive predictive value, negative predictive value and accuracy of mixed imaging alone in diagnosing hemorrhage was 66.67%, 100%, 1005, 96.15% and 96.43%, while the sensibility, specificity, positive predictive value, negative predictive value and accuracy of hemorrhage with DUDE-CT was 100%, 96%, 75%, 100% and 96.43% . The diagnostic accuracy of superimposed fusion images for intracranial hemorrhage, extravasation of contrast agent and hemorrhage with extravasation of contrast agent was relatively high, and the difference was statistically significant (P < 0.05). The diagnostic accuracy of superimposed fusion images consistent with clinical follow-up was significantly higher (Kappa=0.815),as compared with that of mixed imaging alone (Kappa=0.0.564). Conclusion DUDE-CT has great value in differentiating hemorrhage from iodinated contrast after intra-arterial thrombolysis in acute ischemic stroke.
ABSTRACT
Objective:To investigate the clinical efficacy of mechanical solitaire AB stents thrombectomy combined with intra-arterial thrombolysis in the treatment of patient with acute ischemic stroke.Methods:Fifteen patients with acute ischemic stroke admitted into our hospital from August 2014 to August 2016 were treated with mechanical thrombectomy with solitaire AB stents plus intra-arterial thrombolysis.The National Institutes of Health Stroke Scale score (NIHSS) of all patients were evaluated before and after treatment to compare the clinical efficacy.The prognosis ofpatients between two groups were compared via evaluating modified Rankin score (mRS)and gelasijia coma score (GCS).Results:After mechanical thrombectomy with solitaire AB stents plus intra-arterial thrombolysis treatment,14 patients achieved complete or part recanalization,and 1 patient was terminated treatment due to vital signs instability,and the rate ofrecanalization was 93.3％.The NIHSS score of patients before treatment was 12.93± 4.25,which was much higher than that after treatment (4.33± 1.45,P＜0.05).After follow-up by 3 months,the good mRS scores were obtained in all 18 patients,including 2 patients with mRS score of 2,5 patients with 1,and 8 patients with 0.Additionally,there was no patient with re-obstruction during follow-up period.Conclusion:Mechanical thrombectomy with solitaire AB stents combined with intra-arterial thrombolysis had a good capability and safety in the treatment of patients with acute ischemic stroke.
ABSTRACT
PURPOSE: To report two patients who developed central retinal artery occlusion (CRAO) after trauma. CASE SUMMARY: A 26-year-old man complained of severe loss of vision in his left eye after falling and bumping his forehead on a staircase. His visual acuity was light perception in the left eye. Fundus examination revealed edematous white retina and a cherry red spot on the macula. Angiography showed severe stenosis in the initial segment of the ophthalmic artery with ophthalmic arterial embolus. He underwent intra-arterial thrombolysis with a clinical diagnosis of CRAO with ophthalmic artery stenosis. A 57-year-old woman presented with vision loss after falling and striking her face below her right lower eyelid on a wooden stick. Her visual acuity was hand motions in the right eye. Fundus examinations showed white retina with opacity and a cherry red spot on the macula. Fluorescein angiography and optical coherence tomography was performed, and a clinical diagnosis of CRAO was made. CONCLUSIONS: CRAO must be considered when clinically differentiating visual loss after a trauma.
Subject(s)
Adult , Female , Humans , Middle Aged , Angiography , Constriction, Pathologic , Diagnosis , Embolism , Eyelids , Fluorescein Angiography , Forehead , Hand , Ophthalmic Artery , Prunus , Retina , Retinal Artery Occlusion , Retinal Artery , Strikes, Employee , Tomography, Optical Coherence , Visual AcuityABSTRACT
Objective To investigate the clinical nursing effect of intra-arterial thrombolysis immediate contact with stent implantation. Methods A total of 50 patients with acute stroke were divided into the control group and the exper-imental group according to the different care programs, the control group was treated with conventional care, the exper-imental group was treated with perioperative nursing intervention, the nursing effect were compared between two groups. Results The nursing effective rate of experimental group was 92%,was significantly better than the control group (76%),the difference was significant between two groups(P<0.05); The nursing satisfactory rate of experimental group was 92%, was significantly higher than the control group (64%),the difference was significant between two groups (P<0.05); the informed rated score was (44.13±2.25) points, care score was (40.23±1.76) points, improvement score was (153.58±4.65) points in experimental group, were significantly higher than those in the control group(P<0.05); the symptom score was (63.9±13.4) points, the disease knowledge score was (65.3±16.1) points, the emergency management score was (52.1±10.6) points, the daily life score was(83.9±13.2) points in the experimental group, were significantly higher than those in the control group (P<0.05). Conclusion Intracranial stenosis is caused by ischemic stroke vascular accident, the perioperative nursing intervention for the patient vascular stenting implementing ideal have good effect,and can reduce the incidence of postoperative complications, should be introduced.
ABSTRACT
Objective To explore effects of mild hypothermia on early neurological deterioration (END) after main arterial occlusive with intra-arterial thrombolysis. Methods Fifty patients were randomly divided into mild hypothermia and conventional group, to compared the changes of ICP, CVP, MAP, Blood K+, PT, PLT, ScvO2 and NIHSS before- treatment and 24 h and 7 d after- treatment , prognosis and mortality were evaluated by MRS after 90 d. Results (1) Compared with pre-treatment, 7 d NIHSS of mild hypothermia group decreased (P < 0.01); 24 h, 7 d ICP and ScvO2 improved significantly (P < 0.05); 24 h decreased significantly (P <0.05), while 7 d blood K+ showed no differences. (2) Compared with conventional group, mild hypothermia group 7 d NIHSS and 24 h, 7 d ICP and ScvO2 improved significantly (P < 0.05). (3) The CVP, MAP, PT, and PLT showed no difference in two groups before and after-treatment . ( 4 ) Rate of good outcome in mild hypothermia group was significantly higher than conventional group in 90 days (P < 0.01); while the mortality rate showed no difference. Conclusions Mild hypothermia can obviously improve END in stroke with intra-arterial thrombolysise, bring better outcome among survival patients, though can not reduce mortality.
ABSTRACT
Objective To evaluate the efficacy and safety of intra-arterial thrombolysis with recombinant tissue-plasminogen ac-tivator(rt-RA) for treatment of acute cerebral infarction (ACI) .Methods The randomized controlled trials (RCT ) of intra-arterial thrombolysis with rt-PA for treatment of ACI were selected from Cochrane Library ,Medline ,Embase and CBM by the computer re-trieval .A meta analysis of the data were analyzed by using RevMan 5 .1 software .Results A total of 473 patients in 9 selected RCTs were involved in the systematic review .Meta-analysis results disclosed suggested that the effectiveness of intra-arterial thrombolysis treated ACI group was better than that of intravenous thrombolysis group [RR= 1 .26 ,95% CI(1 .09 ,1 .45) ,P=0 .002] .No difference was observed between the two groups in intracranial hemorrhage and mortality rate .Conclusion The current evidence showed that ,the clinical effect of intra-arterial thrombolysis with rt-PA for treatment of ACI was obviously superior to that of intravenous thrombolysis ,but the result still needs to be confirmed by large-sample RCTs .
ABSTRACT
Objective To observe the cerebral edema occurrence ,evolution and prognosis of intra-arterial thrombolytic recanali-zation in patients with acute ischemic stroke .Methods From October 2010 to October 2012 ,36 patients who underwent the intra-arterial thrombolytic therapy were cerebral recanalization .They were randomly divided into two groups :1-3 h group and >3-6 h group .The alteration of brain edema was observed by cranial CT .Their mRS .NHISS and BI were scaled and recorded before and after intra-arterial thrombolytic therapy .Results After intra-arterial thrombolytic therapy ,the occurrence rate of cerebral edema was 94% ,appeared at the onset of more than 1 hours in all patients .Long-term follow-up showed ,cerebral edema location appeared obvious cerebromalacia .Cerebral edema and clinical outcome had not significant difference between 1-3 h group and 3-6 h group . Conclusion Cerebral edema and loss of cerebral tissue occurred almost inevitability in patients who received intra-artery thromboly-sis and recanalized their cerebral artery .It indicates that good local circulation and general condition may be favorable factors that can gradually reduce brain edema .
ABSTRACT
Objective To observe the safety and efficacy ofintra-arterial thrombolysis guided by CT perfusion in patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h.Methods The clinical data of patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h (n=36) and shorter than or equal to 6 h (n=30),performed intra-arterial thrombolysis in our hospitals from July 2003 to December 2012,were retrospectively evaluated.Patients of the former group were evaluated the ischemic penumbra and core region of infarction and the mismatch between the two regions based on CT perfusion.The clinical features,clinical outcomes and complications were compared between the two groups.Results As compared with those in patients of symptoms shorter than or equal to 6 h,the early neurological improvement rate (13.3％ vs.22.2％) and long-term neurological improvement rate (86.7％ vs.77.7％),recanalization rate (80.0％ vs.88.9％) and 3-month mortality (6.7％ vs.16.7％) of patients of symptoms longer than were not significantly different (P=0.665,P=0.665,P=0.639 and P=0.607).Conclusions To patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h,the neurological function at 3-month significantly improves after intra-arterial thrombolysis guided by CT perfusion.Although the incidence of symptomatic intracranial hemorrhage increases,the mortality rate does not significantly increase.
ABSTRACT
Objective To determine the safety and efficacy of intra-arterial urokinase in the treatment of acute cerebral infarction (ACI) patients with computed tomography perfusion-based selection within a 6-9 h window.Methods Fifty-two ACI patients,with computed tomography perfusion imaging (CTPI) identifying thresholds for salvageable penumbra,were randomly assigned to intra-arterial thrombolysis with urokinase (group A) and conventional anti-platelet aggregation (group B) within a 6-9 h window.Whole brain digital subtraction angiography (DSA) was done at pre-and post-treatment to observe the recanalization of occlusive vessels in group A.The National Institutes of Health Stroke scale (NIHSS) 24 h and 7 d after treatment,and modified Rankin Scale (mRS) and Barthel Index (BI) 90 d after treatment were used to evaluate the efficacy.Results In group A,15 patients showed successful recanalization (thrombolysis in myocardial infarction [TIMI] index:grade Ⅲ in 9 and grade Ⅱ in 6) and 12 patients showed unsuccessful recanalization (TIMI index:grade Ⅰ in 6 and grade 0 in 6) with a successful recanalization rate of 55.56％.More obvious NIHSS improvement 24 h and 7 d after treatment in group A was observed than that in group B (P＜0.05),and more patients with favorable outcomes based on mRS and BI in group A were noted than those in group B (P＜0.05).In addition,the incidence of cerebral hemorrhage within 24 h of treatment between the two groups was similar (P＞ 0.05).Conclusions Intra-arterial thrombolysis with urokinase is safe and effective for ACI patients within a 6-9 hour window under the guidance of CTPI.
ABSTRACT
Among the many advances in acute ischemic stroke (AIS) management, thrombolysis with intravenous (IV) tissue plasminogen activator (tPA) within 3 hours after symptom onset has been the only approved pharmacological therapy in AIS. However, IV administration of tPA has many limitations in clinical practice, and the proportion of eligible patients remains quite low. Many clinical trials have attempted to overcome this by increasing the therapeutic time window and enhancing the efficacy of reperfusion by the intra-arterial (IA) approach with novel mechanical devices. In addition, the application of new thrombolytic agents and identification of suitable thrombolytic candidates by multimodal brain imaging is another field of active research in thrombolytic therapy. We reviewed AIS management, focusing on thrombolysis with IV therapy, IA therapy, and IV-IA bridging therapy.
Subject(s)
Humans , Fibrinolytic Agents , Neuroimaging , Reperfusion , Stroke , Thrombolytic Therapy , Tissue Plasminogen ActivatorABSTRACT
Objective To determine the safety and efficacy of intra-arterial recombinant tissue plasminogen activator (r-tPA) for the treatment of acute cerebral infarction (ACI) in patients under the guidance of computed tomography perfusion-based selection within a 6-9 hour window.Methods Sixtythree ACI patients selected by using computed tomography perfusion imaging (CTPI) identifying thresholds for salvageable penumbra were randomly (random number) assigned to the group treated with intra-arterial thrombolysis with r-tPA (group A,n =30) or to the group managed with conventional anti-platelet aggregation agent (group B,n =33) within a 6-9 hour window.The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale score (mRS) and Barthel Index (BI) were used for evaluating therapeutic efficacy.Global brain digital subtraction angiography (DSA) was done pre-and posttreatment to observe the recanalization of occluded vessels in the group A.All patients were monitored with CT scan within 24 hours to determine the cerebral hemorrhage,an unexpected complication of thrombolysis.Results Compared with pre-treatment,there were significant differences in NIHSS 24 hours after treatment in the group A and 7 days after treatment in both groups (P ＜ 0.01).However,there were no significant differences in NIHSS 24 hours after treatment in the group B.More improvements in NIHSS at 24 hours and 7 days after treatment were observed in the group A than those in group B (P ＜ 0.01),and more patients with favorable outcomes identified by mRS and BI in the group A than those in the group B (P =0.017 and P =0.016,respectively).In addition,twenty patients were showed successful recanalization in the group A and there were 2 cases of cerebral hemorrhage occurred in the group A,and there was no significant difference in the incidence of cerebral hemorrhage within 24 hours between the two groups (P ＞ 0.05).Conclusions Intra-arterial thrombolysis with r-tPA for treatment of acute cerebral infarction was safe and effective within a 6-9 hour window under the guidance of CTPI.
ABSTRACT
Objective To compare the efficacy and safety of intravenous and intra-arterial thrombolysis with tissue plasminogen activator in Chinese patients with acute ischemic stroke.Methods Patients with acute ischemic stroke,consecutively registered in our database from 2005 to 2010,were included.Admission demographics,time window,procedure delay in hospital,route of thrombolysis,dose of tissue plasminogen activator,stroke severity,laboratory tests and vital signs of these patients were collected.CT manifestations and TOAST subtypes were obsevred.Outcome variables included hemorrhagic transformation,re-canalization of responsible vessels,favorable functional outcome 90 d after thrombolysis and mortality were evaluated.Univariate and multivariate logistic regression were used to select the potential variables and compare the differences between the two kinds of route in thrombolysis.Results A total of 96 patients were included with one loss of follow-up.Forty-three were male (44.8％) and 53 female.Median age was 72 years,median body weight 58.5 kilograms,and median time window 4.3 hours.Sixty-four patients received intravenous thrombolysis and 32 patients intra-arterial thrombolysis.Favorable outcome was achieved in 43.8％ patients 90 d after thrombolysis with a mortality reaching 17.9％.Univariate analysis showed intra-arterial thrombolysis had a much higher cost (47623.6 vs 25699.8 RMB),longer procedure delay (3.17 h vs 1.73 hours) and time window (5.54 vs 3.58 hours),and lower dose (20 vs 50 mg) as compared with intravenous thrombolysis (P＜0.05);however,no significant differences were found between the 2 groups in re-canalization of responsible vessels (64.9％ vs 53.8％),hemorrhagic transformation (25％ vs 31.3％),favorable outcome (45.3％ vs 40.6％) and mortality (14.7％ vs 3.2％).Multivariate logistic regression indicated that route of thrombolysis did not predict unfavorable outcome (OR=0.54,P=0.824,95％ CI:0.00-131.46);re-canalization could independently predict the functional outcome (OR=0.11,P=0.027,95％ CI:0.02-0.78),while the route of thrombolysis itself did not influence the re-canalization.Conclusion In patients with acute ischemic stroke,the treatment efficacy and safety of intravenous and intra-arterial thrombolysis with tissue plasminogen activator are similar,not enjoying significant difference in hemorrhagic transformation and mortality.
ABSTRACT
Objective To evaluate the feasibility, safety and efficacy of intra-arterial thrombolytic therapy on elderly patients (≥ 80 years old) with acute ischemic stroke. Methods The clinical data of 86 patients with acute ischemic stroke, received intra-arterial thrombolytic therapy, were retrospectively analyzed; according to age differences, these patients were divided into advanced age group (≥80 years old, n=21) and common age group (<80 years old, n=65); and control group (≥80 years old, not receiving thrombolytic therapy, n=50) was established. The recanalization rate and early clinical improvement rate, and the incidence, recover rate and death rate of symptomatic intracerebral hemorrhage were evaluated in these patients after treatment. Results No significant differences in the favorite recanalization rate and short-term outcome, and the incidence of symptom intracranial hemorrhage were noted between the advanced age group and common age group (P=0.528, P=0.102,P=0.353). The incidence of symptom intracranial hemorrhage in the advanced age group was obviously higher than that in the control group (P=0.034); the recover rate of symptom ntracranial hemorrhage in the advanced age group (42.9%) was obviously lower than that in the common age group (50.8%), but significantly higher than that in the control group (16%, P=0.042, P=0.017). The mortality of the advanced age group was similar to that of the control group (23.8% versus 28%, P=0.816), but higher than that of common age group (23.8% versus 10.8%, P=0.034). Conclusion Relatively high feasibility, safety and efficacy of intra-arterial thrombolytic therapy are noted in elderly patients (≥80 years old) with acute ischemic stroke, demonstrating that the use of intra-arterial thrombolytic therapy in very elderly patients should not be avoided but pursued advisably.
ABSTRACT
Objective To investigate the method, time window, dosage of thrombolytic drug used in different intra-arterial thrombolytic therapies of patients with acute cerebral infarction Methods Sixty patients with acute cerebral infarction within 12 h were chosen in our study; they were treated by different intra-arterial thrombolytic therapies. The therapeutic effect (recanalization) were evaluated through cerebral angiography. Results The complete recanalization rate was 55％ (33/60), partial recanalization rate 38.3％ (23/60) and non-efficiency 6.7％ (4/60). Thirty-eight patients (63.3％) were clinically cured, 10 (16.7％) obviously improved, 9 (15％) partially improved and 3 (5％) invalid; no death was noted. Conclusion Treatment of acute cerebral infarction by different intra-arterial thrombolytic therapies is safe and effective. The cure rate will be improved and the death rate and disability rate will be decreased by setting up first aid system and standard therapeutic measurements.
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.
ABSTRACT
According to the "drip and ship" concept, patients who are not responsive to intravenous tissue plasminogen activator (IV-tPA) at a community hospital may be candidates for subsequent intra-arterial (IA) thrombolysis at a comprehensive stroke center. We elucidated the efficacy and safety of combined IV/IA thrombolysis via the drip and ship approach. We retrospectively reviewed patients with acute ischemic stroke who underwent combined IV/IA thrombolysis between March 2006 and June 2009. The patients were divided into two groups (inside hospital IV-tPA vs. outside hospital IV-tPA). We compared the short- and long-term clinical outcome, recanalization rate, intracranial hemorrhage after the procedure, and onset to treatment time between the two groups. A total of 23 patients with inside hospital IV-tPA and 10 patients with outside hospital IV-tPA were included. The mean pre-treatment National Institutes of Health Stroke Scale (NIHSS) scores were 15.8 and 17.5, respectively. Baseline characteristics were not significantly different between the two groups. The NIHSS score at 1 week and favorable outcome rate (modified Rankin Scale < or =2) 3 months after the procedure were not significantly different (p=0.730 and p=0.141, respectively). The rate of recanalization and intracranial hemorrhage were not significantly different (p=0.560 and p=0.730, respectively). The onset to IA thrombolysis time was also not significantly different (222.7 vs. 239.3 minutes, p=0.455). Our results suggest that initiation of IV-tPA in a community hospital with rapid transfer to a comprehensive stroke center for subsequent IA thrombolysis can be a safe and feasible therapeutic option in acute stroke management.
Subject(s)
Humans , Hospitals, Community , Intracranial Hemorrhages , Retrospective Studies , Ships , Stroke , Tissue Plasminogen ActivatorABSTRACT
According to the "drip and ship" concept, patients who are not responsive to intravenous tissue plasminogen activator (IV-tPA) at a community hospital may be candidates for subsequent intra-arterial (IA) thrombolysis at a comprehensive stroke center. We elucidated the efficacy and safety of combined IV/IA thrombolysis via the drip and ship approach. We retrospectively reviewed patients with acute ischemic stroke who underwent combined IV/IA thrombolysis between March 2006 and June 2009. The patients were divided into two groups (inside hospital IV-tPA vs. outside hospital IV-tPA). We compared the short- and long-term clinical outcome, recanalization rate, intracranial hemorrhage after the procedure, and onset to treatment time between the two groups. A total of 23 patients with inside hospital IV-tPA and 10 patients with outside hospital IV-tPA were included. The mean pre-treatment National Institutes of Health Stroke Scale (NIHSS) scores were 15.8 and 17.5, respectively. Baseline characteristics were not significantly different between the two groups. The NIHSS score at 1 week and favorable outcome rate (modified Rankin Scale < or =2) 3 months after the procedure were not significantly different (p=0.730 and p=0.141, respectively). The rate of recanalization and intracranial hemorrhage were not significantly different (p=0.560 and p=0.730, respectively). The onset to IA thrombolysis time was also not significantly different (222.7 vs. 239.3 minutes, p=0.455). Our results suggest that initiation of IV-tPA in a community hospital with rapid transfer to a comprehensive stroke center for subsequent IA thrombolysis can be a safe and feasible therapeutic option in acute stroke management.