Li Yue-Hua, Li Ming-Hua, Zhao Zhen-Guo, Bai Qing-Ke
Department of Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Neurol India. 2009 Jul-Aug;57(4):426-33. doi: 10.4103/0028-3886.55615.
To investigate the outcomes of magnetic resonance imaging (MRI)-based thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute middle cerebral artery (MCA) occlusion in 3-6 hours.
MRI-selected patients (n=15) with acute ischemic stroke in MCA divided into two groups (<or=3 h and 3-6 h) were treated with intravenous rt-PA. MR was performed before rt-PA, at 24 hours, 7 days, and 14 days after stroke. Recanalization was assessed 24 h after thrombolysis, and clinical status was evaluated before rt-PA treatment, 6 hours, 24 hours, 7 days, and 14 days after thrombolysis by the National Institutes of Health Stroke Scale (NIHSS). Modified rankin scale (MRS) was used to assess clinical outcome at 30 and 90 days after thrombolysis.
There was no significant between <or=3 h and 3-6 h group in length of hospital stay, recanalization, MRS, and favorable outcome at 90 days. Recanalization within 24 hours occurred in 9 (60%), and nonrecanalization in 6 (40%). One patient in recanalization group and three in nonrecanalization group had an asymptomatic intracranial hemorrhage (ICH) within 24 h after thrombolysis (P=0.235). Recanalization with thrombolysis was associated with a better outcome regardless of the time point of rt-PA treatment. Comparison with nonrecanalization group, recanalization was also associated with a lower NIHSS score at 14 days (P=0.003), a lower TIMI grade at 7 days (P<0.001), and a shorter length of hospital stay (P=0.018).
Our study suggested that MR-based thrombolysis using rt-PA was safe and reliable in patients with acute MCA occlusion in 3-6 hours.
探讨在发病3 - 6小时的急性大脑中动脉（MCA）闭塞患者中，使用重组组织型纤溶酶原激活剂（rt-PA）进行基于磁共振成像（MRI）的溶栓治疗的效果。
将MRI筛选出的15例MCA急性缺血性卒中患者分为两组（≤3小时组和3 - 6小时组），给予静脉rt-PA治疗。在rt-PA治疗前、卒中后24小时、7天和14天进行磁共振成像检查。溶栓后24小时评估血管再通情况，在rt-PA治疗前、溶栓后6小时、24小时、7天和14天，采用美国国立卫生研究院卒中量表（NIHSS）评估临床状态。采用改良Rankin量表（MRS）评估溶栓后30天和90天的临床结局。
≤3小时组和3 - 6小时组在住院时间、血管再通情况、MRS评分及90天时的良好结局方面无显著差异。24小时内血管再通者9例（60%），未再通者6例（40%）。再通组1例患者和未再通组3例患者在溶栓后24小时内发生无症状颅内出血（ICH）（P = 0.235）。无论rt-PA治疗的时间点如何，溶栓后血管再通与更好的结局相关。与未再通组相比，再通组在14天时NIHSS评分更低（P = 0.003），7天时TIMI分级更低（P < ？001），住院时间更短（P = 0.018）。
我们的研究表明，在发病3 - 6小时的急性MCA闭塞患者中，使用rt-PA进行基于MRI的溶栓治疗是安全可靠的。
