King S, Khatri P, Carrozella J, Spilker J, Broderick J, Hill M, Tomsick T
Clinical Coordinating Center, IMS Studies, University of Cincinnati, Cincinnati, OH, USA.
AJNR Am J Neuroradiol. 2007 Nov-Dec;28(10):1890-4. doi: 10.3174/ajnr.A0702. Epub 2007 Sep 26.
Anterior cerebral artery (ACA) emboli may occur before or during fibrinolytic revascularization of middle cerebral artery (MCA) and internal carotid artery (ICA) T occlusions. We sought to determine the incidence and effect of baseline and new embolic ACA occlusions in the Interventional Management of Stroke (IMS) studies.
Case report forms, pretreatment and posttreatment arteriograms, and CTs from 142 subjects entered into IMS I & II were reviewed to identify subjects with baseline ACA occlusion, new ACA emboli occurring during fibrinolysis, subsequent CT-demonstrated infarction in the ACA distribution, and to evaluate global and lower extremity motor clinical outcome.
During M1/M2 thrombolysis procedures, new ACA embolus occurred in 1 of 60 (1.7%) subjects. Baseline distal emboli were identified in 3 of 20 (15%) T occlusions before intra-arterial (IA) treatment, and new posttreatment distal ACA emboli were identified in 3 subjects. At 24 hours, 8 (32%) T occlusions demonstrated CT-ACA infarct, typically of small volume. Infarcts were less common following sonography microcatheter-assisted thrombolysis compared with standard microcatheter thrombolysis (P = .05). Lower extremity weakness was present in 9 of 10 subjects with ACA embolus/infarct at 24 hours. The modified Rankin 0 to 2 outcomes were achieved in 4 of 25 (16%) subjects with T occlusion overall, but in 0 of 10 subjects with distal ACA emboli or ACA CT infarcts (P = .07).
With IV/IA recombinant tissue plasminogen activator treatment for MCA emboli, new ACA emboli are uncommon events. Distal ACA emboli during T-occlusion thrombolysis are not uncommon, typically lead to small ACA-distribution infarcts, and may limit neurologic recovery.
大脑前动脉（ACA）栓塞可能在大脑中动脉（MCA）和颈内动脉（ICA）T形闭塞的纤溶再灌注之前或期间发生。我们试图确定在卒中介入治疗（IMS）研究中基线和新发性栓塞性ACA闭塞的发生率及影响。
回顾了142例纳入IMS I和II研究的受试者的病例报告表、治疗前和治疗后的血管造影片以及CT，以确定有基线ACA闭塞、纤溶过程中出现新的ACA栓子、随后CT显示的ACA供血区梗死的受试者，并评估总体及下肢运动临床结局。
在M1/M2溶栓过程中，60例受试者中有1例（占1.7%）出现新的ACA栓子。在动脉内（IA）治疗前，20例T形闭塞中有3例（占15%）发现基线远端栓子，治疗后有3例受试者发现新的远端ACA栓子。在24小时时，8例（占32%）T形闭塞显示有CT-ACA梗死，通常梗死体积较小。与标准微导管溶栓相比，超声微导管辅助溶栓后梗死较少见（P = 0.05）。在24小时时，10例有ACA栓子/梗死的受试者中有9例出现下肢无力。总体而言，25例T形闭塞受试者中有4例（占16%）达到改良Rankin 0至2级结局，但10例有远端ACA栓子或ACA CT梗死的受试者中无一例达到该结局（P = 0.07）。
采用静脉内/动脉内重组组织型纤溶酶原激活剂治疗MCA栓子时，新的ACA栓子是罕见事件。T形闭塞溶栓期间远端ACA栓子并不少见，通常导致小的ACA供血区梗死，并可能限制神经功能恢复。
