Mangiafico Salvatore, Cellerini Martino, Nencini Patrizia, Gensini Gianfranco, Inzitari Domenico
Department of Neuroradiology, Careggi Hospital, Florence, Italy.
AJNR Am J Neuroradiol. 2005 Nov-Dec;26(10):2595-601.
The purpose of this study was to evaluate preliminarily the efficacy and safety of intravenous tirofiban combined with intra-arterial pharmacologic and mechanical thrombolysis in patients with stroke.
Twenty-one consecutive patients with an acute ischemic stroke due to major cerebral arteries occlusion and a National Institutes of Health Stroke Scale [NIHSS] score > or = 18 were treated with an intravenous bolus of tirofiban and heparin followed by intra-arterial administration of urokinase coupled with mechanical thrombolysis.
Thirteen patients had an anterior circulation stroke (T-siphon internal carotid artery [ICA] = 7; middle cerebral artery [MCA] = 6), 6 patients a posterior circulation stroke, and 2 patients an anterior plus posterior circulation stroke (left ICA or M1 tract of MCA plus basilar artery occlusions). Mean NIHSS score on admission was 21 (range, 18-27). Immediate recanalization was successful (thrombolysis in myocardial infarction [TIMI] 2-3) in 17 of 21 patients. The following day, 14 of 19 patients improved substantially and complete vessel patency (TIMI 3-4) was confirmed by digital subtraction angiography. Intracranial bleeding occurred in 5 of 21 patients (3 symptomatic cerebral hemorrhages and 2 subarachnoid hemorrhages) and was fatal in the case of 3 patients. At discharge, the mean NIHSS was 5.4 (range, 0-25). Overall, at 3-month follow-up the functional outcome was favorable (modified Rankin Scale score = 0-2) in 13 of 21 (62%) patients. Death (including all causes) at 90 days occurred in 6 of 21 (28%) cases.
The combination of intravenous tirofiban with intra-arterial urokinase and mechanical thrombolysis may be successful in reestablishing vessel patency and result in a good functional outcome in patients with major cerebral arteries occlusions.
本研究旨在初步评估静脉注射替罗非班联合动脉内药物溶栓及机械溶栓治疗卒中患者的疗效和安全性。
连续纳入21例因大脑主要动脉闭塞导致急性缺血性卒中且美国国立卫生研究院卒中量表（NIHSS）评分≥18分的患者，先静脉推注替罗非班和肝素，随后动脉内给予尿激酶并联合机械溶栓。
13例患者为前循环卒中（颈内动脉虹吸段=7例；大脑中动脉=6例），6例为后循环卒中，2例为前循环加后循环卒中（左侧颈内动脉或大脑中动脉M1段加基底动脉闭塞）。入院时NIHSS评分均值为21分（范围18 - 27分）。21例患者中有17例实现即刻再通（心肌梗死溶栓分级[TIMI] 2 - 3级）。次日，19例患者中有14例显著改善，数字减影血管造影证实14例血管完全通畅（TIMI 3 - 4级）。21例患者中有5例发生颅内出血（3例症状性脑出血和2例蛛网膜下腔出血），其中3例患者死亡。出院时，NIHSS评分均值为5.4分（范围0 - 25分）。总体而言，在3个月随访时，21例患者中有13例（62%）功能结局良好（改良Rankin量表评分=0 - 2分）。21例患者中有6例（28%）在90天时死亡（包括各种原因）。
静脉注射替罗非班联合动脉内尿激酶及机械溶栓可能成功重建血管通畅，并使大脑主要动脉闭塞患者获得良好的功能结局。
