Labiche Lise A, Malkoff Marc, Alexandrov Andrei V
Stroke Program, University of Texas Medical School at Houston, TX, USA.
J Neuroimaging. 2003 Jan;13(1):28-33.
Residual blood flow around thrombus prior to treatment predicts success of coronary thrombolysis. The authors aimed to correlate the presence of residual flow signals in the middle cerebral artery (MCA) with completeness of recanalization after intravenous tissue plasminogen activator (TPA).
The authors studied consecutive patients treated with intravenous TPA therapy who had a proximal MCA occlusion on pretreatment transcranial Doppler (TCD). Patients were continuously monitored for 2 hours after TPA bolus. Absent residual flow signals correspond to the thrombolysis in brain ischemia (TIBI) 0 grade, and the presence of residual flow signals was determined as TIBI 1-3 flow grades. Complete recanalization was defined as flow improvement to TIBI grades 4-5.
Seventy-five patients with a proximal MCA occlusion had median pre-bolus NIHSS 16 (85% with > or = 10 points). TPA bolus was given at 141 +/- 56 minutes (median 120 minutes). Complete recanalization was observed in 25 (33%), partial in 23 (31%), and no early recanalization was seen in 27 (36%) patients within 2 hours after TPA bolus. Only 19% with absent residual flow signals (TIBI grade 0, n = 26) on pretreatment TCD had complete early recanalization. If pretreatment TCD showed the presence of any residual flow (TIBI 1-3, n = 49), 41% had complete recanalization within 2 hours of TPA bolus (P = .03).
Patients with detectable residual flow signals before IV TPA bolus are twice as likely to have early complete recanalization. Those with no detectable residual flow signals have less than 20% chance for complete early recanalization with intravenous TPA and may be candidates for intra-arterial therapies.
治疗前血栓周围的残余血流可预测冠状动脉溶栓的成功率。作者旨在将大脑中动脉（MCA）残余血流信号的存在与静脉注射组织纤溶酶原激活剂（TPA）后的再通完整性相关联。
作者研究了连续接受静脉TPA治疗且在治疗前经颅多普勒（TCD）显示近端MCA闭塞的患者。TPA推注后连续监测患者2小时。无残余血流信号对应脑缺血溶栓（TIBI）0级，残余血流信号的存在被确定为TIBI 1 - 3级血流分级。完全再通定义为血流改善至TIBI 4 - 5级。
75例近端MCA闭塞患者推注前美国国立卫生研究院卒中量表（NIHSS）中位数为16（85%患者评分≥10分）。TPA推注时间为141±56分钟（中位数120分钟）。TPA推注后2小时内，25例（33%）患者实现完全再通，23例（31%）部分再通，27例（36%）患者未早期再通。治疗前TCD无残余血流信号（TIBI 0级，n = 26）的患者中，仅19%实现早期完全再通。如果治疗前TCD显示存在任何残余血流（TIBI 1 - 3级，n = 49），41%患者在TPA推注后2小时内实现完全再通（P = 0.03）。
静脉推注TPA前可检测到残余血流信号的患者早期完全再通的可能性是其他患者的两倍。未检测到残余血流信号的患者通过静脉TPA实现早期完全再通的机会不到20%，可能是动脉内治疗的候选者。
