Cross D T, Derdeyn C P, Moran C J
Department of Radiology, Box 8131, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA.
AJNR Am J Neuroradiol. 2001 Mar;22(3):521-5.
Fibrinolysis with local intraarterial urokinase infusion for basilar artery thrombosis has been associated with a low rate of spontaneous symptomatic cerebral hemorrhage, even when patients have been treated late in the course of symptoms. Because urokinase is presently unavailable in the United States, this study was undertaken to determine the frequency of spontaneous cerebral hemorrhage in basilar artery fibrinolysis performed with tissue plasminogen activator (tPA).
In a retrospective review of our initial experience with cerebral fibrinolysis for acute stroke using intraarterial tPA, four cases of basilar thrombosis were identified. Doses of the fibrinolytic agent and heparin, angiographic findings, clinical courses, and bleeding complications for these patients were determined. These results were compared with those from a prior study of 20 similar consecutive patients treated with urokinase.
Symptom duration before treatment was unlimited. Intraarterial doses of tPA were 20 to 50 mg. Patients received full systemic anticoagulation with heparin. Complete basilar artery recanalization was achieved in 75% of patients. Two patients treated with tPA had angioplasty and stent placement for related high-grade stenosis. Spontaneous symptomatic cerebral hemorrhage occurred in three (75%) of the four tPA-treated patients and in three (15%) of the 20 urokinase-treated patients.
The cerebral hemorrhage complication rate for intraarterial fibrinolysis with tPA was very high in cases of basilar artery thrombosis at the doses we used. Protocol adjustments should be considered.
即使患者在症状出现后期才接受治疗，局部动脉内注入尿激酶治疗基底动脉血栓形成时，自发性症状性脑出血的发生率也较低。由于目前美国无法获得尿激酶，因此开展本研究以确定使用组织型纤溶酶原激活剂（tPA）进行基底动脉纤溶治疗时自发性脑出血的发生频率。
回顾性分析我们最初使用动脉内tPA进行急性脑卒中脑纤溶治疗的经验，确定了4例基底动脉血栓形成病例。确定了这些患者的纤溶药物和肝素剂量、血管造影结果、临床病程及出血并发症情况。将这些结果与先前一项对20例连续接受尿激酶治疗的类似患者的研究结果进行比较。
治疗前症状持续时间不限。动脉内tPA剂量为20至50mg。患者接受了肝素全身充分抗凝治疗。75%的患者实现了基底动脉完全再通。2例接受tPA治疗的患者因相关高度狭窄接受了血管成形术和支架置入术。4例接受tPA治疗的患者中有3例（75%）发生了自发性症状性脑出血，20例接受尿激酶治疗的患者中有3例（15%）发生了自发性症状性脑出血。
在我们使用的剂量下，tPA动脉内纤溶治疗基底动脉血栓形成时脑出血并发症发生率非常高。应考虑调整方案。
