Eckert Bernd, Kucinski Thomas, Neumaier-Probst Eva, Fiehler Jens, Röther Joachim, Zeumer Hermann
Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Cerebrovasc Dis. 2003;15(4):258-63. doi: 10.1159/000069493.
To evaluate the effect of occlusion type and fibrinolytic agent on recanalization success and clinical outcome in patients undergoing local intra-arterial fibrinolysis (LIF) in acute hemispheric stroke.
LIF was performed in 137 patients with angiographically established occlusion in the carotid circulation within 6 h of stroke onset. Retrospective analysis included recanalization success, recanalization time, type of occlusion and fibrinolytic treatment mode. Five types of occlusion were categorized: intracranial bifurcation (carotid 'T') of the internal carotid artery (ICA; n = 35); proximal segment of the middle cerebral artery (MCA; n = 66); distal segment of the MCA (n = 20); extracranial ICA with MCA embolism (n = 8); multiple peripheral branches of the anterior cerebral artery and the MCA (n = 8). Neurologic outcome was evaluated after 3 months by Barthel Index (BI) as good (BI >90), moderate (BI 50-90), poor (BI <50) or death.
Recanalization was achieved in 74 patients (54%). Mean recanalization time in recanalized patients was 91 min. Neurologic outcome was good in 48 patients (35%), moderate in 34 (25%), poor in 30 (22%) and 25 died (18%). Outcome was significantly better in recanalized than in nonrecanalized patients (p < 0.001). Treatment results were significantly better in proximal and distal MCA occlusion than in carotid 'T' occlusions (p < 0.001). Recanalization success hardly differed between urokinase and rt-PA. Combined treatment with rt-PA and lys-plasminogen tended toward a faster recanalization. Parenchymal hemorrhage occurred in 13 patients (9%).
The type of occlusion is of high prognostic value for successful fibrinolysis in the anterior circulation. However, recanalization is a time-consuming process even with an intra-arterial approach. Recanalization did not differ between type or dosage of plasminogen activators. Further innovative attempts are warranted towards hastening recanalization time in endovascular acute stroke treatment.
评估闭塞类型和纤溶药物对急性半球性卒中患者局部动脉内纤溶治疗（LIF）再通成功率和临床结局的影响。
对137例在卒中发作6小时内经血管造影证实颈动脉循环存在闭塞的患者进行LIF治疗。回顾性分析包括再通成功率、再通时间、闭塞类型和纤溶治疗方式。闭塞分为五种类型：颈内动脉（ICA）颅内分叉处（颈动脉“T”形）（n = 35）；大脑中动脉（MCA）近端段（n = 66）；MCA远端段（n = 20）；颅外ICA合并MCA栓塞（n = 8）；大脑前动脉和MCA的多个外周分支（n = 8）。3个月后通过Barthel指数（BI）评估神经功能结局，分为良好（BI>90）、中度（BI 50 - 90）、差（BI<50）或死亡。
74例患者（54%）实现再通。再通患者的平均再通时间为91分钟。48例患者（35%）神经功能结局良好，34例（25%）为中度，30例（22%）为差，25例死亡（18%）。再通患者的结局明显优于未再通患者（p<0.001）。近端和远端MCA闭塞的治疗效果明显优于颈动脉“T”形闭塞（p<0.001）。尿激酶和rt - PA之间的再通成功率差异不大。rt - PA与赖氨酸纤溶酶原联合治疗倾向于更快再通。13例患者（9%）发生实质内出血。
闭塞类型对前循环纤溶治疗成功具有很高的预后价值。然而，即使采用动脉内方法，再通也是一个耗时的过程。纤溶酶原激活剂的类型或剂量之间再通情况无差异。有必要进行进一步的创新尝试以加快血管内急性卒中治疗的再通时间。
