Ota S, Ota T, Goto K, Inoue I, Ota T
Departmental and institutional affiliation, 1-5: Brain Attack Center Oota Memorial Hospital, Fukuyama, Hiroshima; Japan -
Interv Neuroradiol. 2004 Sep 30;10(3):213-23. doi: 10.1177/159101990401000303. Epub 2005 Jan 5.
This study evaluated: 1) the effect of recanalization on changing clinical outcome, 2) the relationship between dose of Urokinase (UK) and incidence of recanalization and intracranial haemorrhage, and 3) the efficacy and feasibility of balloon disruption (BD) in the treatment of acute cerebral embolism. Sixty-one patients with acute embolism of the major cerebral arteries treated by endovascular approaches over the past nine years were retrospectively evaluated. Among them, 30 cases were treated by BD alone or in conjunction with intra- arterial fibrinolysis in the last five years. The other 31 cases, mostly treated in the first four years, were treated with intra-arterial fibrinolysis alone and were used as controls to evaluate the efficacy of BD. Control angiography was performed just after the reperfusion procedure to evaluate the degree of recanalization. Angiographic responses were graded using modified Thrombolysis in Myocardial Infarction (TIMI) criteria. Clinical outcome was evaluated using modified Rankin Scale (mRS) score at the time of discharge. Thirty-six of the 61 patients (59.0%) achieved high-grade recanalization (TIMI grade 3). Significantly more patients attained favorable outcome (mRS score 0-1) in the high-grade recanalization group than the low-grade recanalization group (41.7% vs. 16.0%, p < 0.05). Concerning patients treated with BD, significantly more patients attained good recanalization and significantly more patients were ambulatory (mRS score 0-3) than those treated with intra-arterial fibrinolysis alone (76.7% vs. 41.9%, p < 0.01; 70.0% vs. 41.9%, p < 0.05, respectively). A significantly lower dose of UK was used, and relatively less intracranial haemorrhage was seen in patients treated with BD than those treated with intra- arterial fibrinolysis (194,000 +/- 191,000 units vs. 388,000 +/- 231,000 units, p=0.001; 16.7% vs. 38.7%, p=0.055, respectively). Concerning morbidity and mortality of BD, there was one death caused by dissection of the M2 portion of the middle cerebral artery (MCA) that happened during BD on a distally migrated embolus. Although no conclusions can be drawn from our study, a favorable outcome for acute embolism of the major cerebral arteries is expected by attaining good recanalization. In addition, BD is an effective technique that can achieve high-grade recanalization alone, or reducing the dose of fibrinolytic agent.
1）再通对临床结局变化的影响；2）尿激酶（UK）剂量与再通及颅内出血发生率之间的关系；3）球囊破裂术（BD）治疗急性脑栓塞的疗效和可行性。回顾性评估了过去九年中采用血管内治疗方法治疗的61例大脑主要动脉急性栓塞患者。其中，在过去五年中，30例患者单独接受BD治疗或联合动脉内溶栓治疗。另外31例患者（大多在最初四年接受治疗）仅接受动脉内溶栓治疗，并作为对照来评估BD的疗效。在再灌注操作刚结束后进行对照血管造影，以评估再通程度。血管造影反应采用改良的心肌梗死溶栓（TIMI）标准进行分级。在出院时使用改良Rankin量表（mRS）评分评估临床结局。61例患者中有36例（59.0%）实现了高级别再通（TIMI 3级）。高级别再通组中获得良好结局（mRS评分0 - 1）的患者明显多于低级别再通组（41.7%对16.0%，p < 0.05）。关于接受BD治疗的患者，与仅接受动脉内溶栓治疗的患者相比，实现良好再通的患者明显更多，且能行走（mRS评分0 - 3）的患者也明显更多（分别为76.7%对41.9%，p < 0.01；70.0%对41.9%，p < 0.05）。接受BD治疗的患者使用的UK剂量明显更低，且颅内出血相对较少，与接受动脉内溶栓治疗的患者相比（分别为194,000 ± 191,000单位对388,000 ± 231,000单位，p = 0.001；16.7%对38.7%，p = 0.055）。关于BD的发病率和死亡率，有1例因大脑中动脉（MCA）M2段夹层在BD治疗远端迁移栓子时发生死亡。尽管我们的研究无法得出结论，但通过实现良好再通有望获得大脑主要动脉急性栓塞的良好结局。此外，BD是一种有效的技术，可单独实现高级别再通，或减少纤溶药物的剂量。
