Barnwell S L, Clark W M, Nguyen T T, O'Neill O R, Wynn M L, Coull B M
Department of Neurosurgery, Oregon Health Sciences University, Portland 97201.
AJNR Am J Neuroradiol. 1994 Nov;15(10):1817-22.
To evaluate safety and efficacy of delayed intraarterial urokinase therapy with mechanical disruption of clot to treat thromboembolic stroke.
Thirteen patients with cerebral thrombolic disease (10 carotid territory, 3 basilar territory) were treated with catheter-directed intraarterial urokinase therapy with mechanical disruption of the clots. All patients were excluded from a 6-hour multicenter thrombolytic trial by either time, recent surgery, age, seizure, or myocardial infarction. Time elapsed before treatment ranged from 3.5 to 48 hours (12 +/- 13 hours), with 200,000 to 900,000 U of urokinase used.
Ten patients had successful vessel recanalization, confirmed by repeat angiography. Cases with distal branch vessel occlusions were less likely to recanalize. Asymptomatic hemorrhagic conversion occurred in 2 patients on repeat scans. Both acute neurologic and functional outcomes were assessed with significant improvement occurring in 9 (69%) of 13 patients at 48 hours (greater than four-point change on the National Institutes of Health scale) and in 100% of 3-month survivors. All patients who improved had normal initial CT scans.
Intraarterial cerebral thrombolysis with mechanical disruption of clot seems to be a useful therapy in selected stroke cases even after 6 hours.
评估延迟动脉内使用尿激酶并结合机械性血栓破碎治疗血栓栓塞性中风的安全性和有效性。
13例脑栓塞疾病患者（10例为颈动脉区域，3例为基底动脉区域）接受了导管引导下动脉内尿激酶治疗并进行机械性血栓破碎。所有患者因时间、近期手术、年龄、癫痫发作或心肌梗死被排除在一项6小时的多中心溶栓试验之外。治疗前经过的时间为3.5至48小时（12±13小时），使用的尿激酶剂量为200,000至900,000单位。
10例患者血管再通成功，经重复血管造影证实。远端分支血管闭塞的病例再通的可能性较小。2例患者在重复扫描时出现无症状性出血转化。对急性神经功能和功能结局进行了评估，13例患者中有9例（69%）在48小时时出现显著改善（美国国立卫生研究院量表上变化超过4分），3个月存活者中100%出现改善。所有病情改善的患者初始CT扫描均正常。
即使在6小时后，动脉内脑溶栓结合机械性血栓破碎在某些中风病例中似乎也是一种有效的治疗方法。
