Pillai J J, Lanzieri C F, Trinidad S B, Tarr R W, Sunshine J L, Lewin J S
Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Ohio, USA.
Radiology. 2001 Mar;218(3):733-8. doi: 10.1148/radiology.218.3.r01mr40733.
To determine whether the initial angiographic morphology and location of intracranial arterial occlusions in acute stroke are reliable predictors of success of thrombolysis.
Thirty-three intracranial occlusions were studied in 32 patients who underwent intraarterial thrombolysis with urokinase within 6 hours from clinical onset of stroke symptoms. The initial angiographic appearance of each occlusion was categorized as cutoff, tapered, meniscus, tram-track, or tandem. Following thrombolysis, outcomes were classified as complete, partial, or no recanalization.
Complete recanalization was accomplished in 17 of the 33 lesions, partial recanalization in nine, and no effect in seven. Tram-track (n = 3) and tapered (n = 7) lesions demonstrated the highest rates of at least partial recanalization (100% and 86%, respectively), whereas cutoff lesions (n = 13) demonstrated the lowest rate (69%). Intracranial hemorrhage was associated with higher doses of urokinase. Complete recanalization success rates were 60% for M1 lesions (n = 10), 43% for M2 or A2 lesions (n = 14), and 33% for M3 lesions (n = 3). Vertebrobasilar lesion (n = 5) success rates for complete and at least partial recanalization were 80% and 100%, respectively.
Relationships were found to exist between the success rate of recanalization and initial angiographic lesion location and morphology, which represent important trends; however, further studies with a larger sample size are needed.
确定急性卒中时颅内动脉闭塞的初始血管造影形态和位置是否是溶栓成功的可靠预测指标。
对32例在卒中症状临床发作后6小时内接受尿激酶动脉内溶栓治疗的患者的33处颅内闭塞进行了研究。将每个闭塞的初始血管造影表现分类为截断型、逐渐变细型、半月板型、轨道型或串联型。溶栓后，结局分为完全再通、部分再通或未再通。
33处病变中有17处实现了完全再通，9处部分再通，7处无效果。轨道型（n = 3）和逐渐变细型（n = 7）病变的至少部分再通率最高（分别为100%和86%），而截断型病变（n = 13）的再通率最低（69%）。颅内出血与较高剂量的尿激酶有关。M1段病变（n = 10）的完全再通成功率为60%，M2或A2段病变（n = 14）为43%，M3段病变（n = 3）为33%。椎基底动脉病变（n = 5）的完全再通和至少部分再通成功率分别为80%和100%。
发现再通成功率与初始血管造影病变位置和形态之间存在关系，这些代表了重要趋势；然而，需要更大样本量的进一步研究。
