Qureshi A I, Boulos A S, Hanel R A, Suri M F K, Yahia A M, Alberico R A, Hopkins L N
Zeenat Qureshi Stroke Research Center and Department of Neurology and Neurosciences, Neurological Institute of New Jersey, 90 Bergen Street, DOC-8100, Newark, NJ 07103, USA.
Neuroradiology. 2004 Dec;46(12):988-95. doi: 10.1007/s00234-004-1180-8. Epub 2004 Dec 4.
We compared the rates of recanalization cerebral infarct and hemorrhage between intra-arterial (i.a.) reteplase and intravenous (i.v.) alteplase thrombolysis in a canine model of basilar artery thrombosis. Thrombosis was induced by injecting a clot in the basilar artery of 13 anesthetized dogs via superselective catheterization. The animals were randomized in a blinded fashion, 2 h after clot injection and verification of arterial occlusion, to receive i.v. alteplase 0.9 mg/kg over 60 min and i.a. placebo, or i.a. reteplase 0.09 units/kg over 20 min, equivalent to one-half the alteplase dose, and i.v. placebo. Recanalization was studied for 6 h after treatment with serial angiography; the images were later graded in a blinded fashion. Blinded interpretation of postmortem MRI was performed to assess the presence of brain infarcts and/or hemorrhage. At 3 h after initiation of treatment, partial or complete recanalization was observed in one of six dogs in the i.v. alteplase group and in five of seven in the i.a. reteplase group (P = 0.08). At 6 h, no significant difference in partial or complete recanalization was observed between the groups (two of six vs. five of seven; P = 0.20). Postmortem MRI revealed infarcts in four of six animals treated with i.v. alteplase and three of seven treated with i.a. reteplase (P = 0.4). Intracerebral hemorrhage was more common in the i.v. alteplase group (four of six vs. none of seven; P = 0.02). This study thus suggests that i.a. thrombolysis affords a recanalization rate similar to that of i.v. thrombolysis, but with a lower rate of intracerebral hemorrhage.
在基底动脉血栓形成的犬模型中，我们比较了动脉内注射瑞替普酶与静脉注射阿替普酶溶栓治疗后大脑梗死再通率及出血情况。通过超选择性导管插入术向13只麻醉犬的基底动脉内注入血凝块诱导血栓形成。在注入血凝块并确认动脉闭塞2小时后，将动物以盲法随机分组，分别接受静脉注射60分钟内给予0.9mg/kg阿替普酶及动脉内给予安慰剂，或动脉内20分钟内给予0.09单位/kg瑞替普酶（相当于阿替普酶剂量的一半）及静脉内给予安慰剂。治疗后通过连续血管造影研究6小时的再通情况；随后以盲法对图像进行分级。对死后MRI进行盲法解读以评估脑梗死和/或出血的存在情况。治疗开始后3小时，静脉注射阿替普酶组6只犬中有1只观察到部分或完全再通，动脉内注射瑞替普酶组7只犬中有5只观察到部分或完全再通（P = 0.08）。6小时时，两组之间在部分或完全再通方面未观察到显著差异（6只中的2只 vs. 7只中的5只；P = 0.20）。死后MRI显示，静脉注射阿替普酶治疗的6只动物中有4只出现梗死，动脉内注射瑞替普酶治疗的7只动物中有3只出现梗死（P = 0.4）。脑出血在静脉注射阿替普酶组更为常见（6只中的4只 vs. 7只中的0只；P = 0.02）。因此，本研究表明动脉内溶栓的再通率与静脉内溶栓相似，但脑出血发生率较低。
