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Objective To explore the Efficacy and safety of intravenous thrombolysis with different doses of rt-PA in the treatment of acute anterior circulation cerebral infarction with atrial fibrillation.Methods Retrospective analysis of 61 cases of patients with anterior circulation of cerebral infarction with atrial fibrillation from October 2009 to October 2014 in the First Affiliated Hospital of Xiamen University, the incidence within 4.5 hours of intravenous thrombolysis,and divided into two groups by rt-PA usage,19 cases in adequate group,received 0.9 mg/kg rt-PA intravenous thrombolytic therapy,42 cases in low dose group, received 0.6 mg/kg rt-PA intravenous thrombolysis.Before and after thrombolysis 1,7 and 30 days,NIHSS score was measured, the indexes of coagulation were observed at before thrombolysis and 1,7 days after thrombolysis,,CT scans were performed at 1, 7, and 14 days after thrombolysis,and Rankin (MRS) scores were compared at 90 days after thrombolysis.Results NIHSS 1,7,30 days scores of 2 groups were significantly decreased after thrombolysis(P<0.05),there was no statistically significant at at each time point after thrombolysis.Plasma prothrombin time increased significantly at 1 day and 7 days after thrombolysis,fibrinogen was significantly lower,compared with the low dose group, the difference was significant (P<0.05).There was no significant difference between the two groups in clinical outcome and mortality.The rate of mucosal bleeding in low dose group was lower than that in adequate group (P<0.05).Conclusion Low-dose rt-PA group intravenous thrombolysis with anterior circulation of atrial fibrillation is more safe,can reduce the risk of bleeding, reduce neurological deficits and improve the quality of life of patients.
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Objective To investigate effect of butylphthalide on serum sex hormone,5-HT and sleep quality in patients with stroke sleep disorder. Methods 240 patients with stroke sleep disorder in our hospital were selected,according to clinical medication were divided into 2 groups.Control group (n=120) were treated by routine treatment, experimental group (n=120) was treated on the base of the control group with butylphthalide.Serum sex hormones, 5-HT and PSQI levels were detected after the treatment.Results Compared with the control group,LH, FSH levels of the experiment were higher(P<0.05),E2 level was lower(P<0.05),serum 5-TH level was higher(P<0.05),PSQI score was lower(P<0.05),the difference was statistically significant.Conclusion Butylphthalide can improve stroke sleep disorder serum sex hormone and 5-HT levels, improve sleep quality, has guiding significance for the treatment.
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Objective To determine the safety and efficacy of intra-arterial recombinant tissue plasminogen activator (r-tPA) for the treatment of acute cerebral infarction (ACI) in patients under the guidance of computed tomography perfusion-based selection within a 6-9 hour window.Methods Sixtythree ACI patients selected by using computed tomography perfusion imaging (CTPI) identifying thresholds for salvageable penumbra were randomly (random number) assigned to the group treated with intra-arterial thrombolysis with r-tPA (group A,n =30) or to the group managed with conventional anti-platelet aggregation agent (group B,n =33) within a 6-9 hour window.The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale score (mRS) and Barthel Index (BI) were used for evaluating therapeutic efficacy.Global brain digital subtraction angiography (DSA) was done pre-and posttreatment to observe the recanalization of occluded vessels in the group A.All patients were monitored with CT scan within 24 hours to determine the cerebral hemorrhage,an unexpected complication of thrombolysis.Results Compared with pre-treatment,there were significant differences in NIHSS 24 hours after treatment in the group A and 7 days after treatment in both groups (P ＜ 0.01).However,there were no significant differences in NIHSS 24 hours after treatment in the group B.More improvements in NIHSS at 24 hours and 7 days after treatment were observed in the group A than those in group B (P ＜ 0.01),and more patients with favorable outcomes identified by mRS and BI in the group A than those in the group B (P =0.017 and P =0.016,respectively).In addition,twenty patients were showed successful recanalization in the group A and there were 2 cases of cerebral hemorrhage occurred in the group A,and there was no significant difference in the incidence of cerebral hemorrhage within 24 hours between the two groups (P ＞ 0.05).Conclusions Intra-arterial thrombolysis with r-tPA for treatment of acute cerebral infarction was safe and effective within a 6-9 hour window under the guidance of CTPI.
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ObjectiveTo evaluate the impact of iFlow in the auxiliary diagnosis of cerebral vascular diseases.Methods Totally 65 patients with cerebral vascular diseases underwent whole brain 2D DSA.Then the data were converted to color coded images with iFlow.The vascular anatomy,the shape and size of lesions,the blood dynamics on 2D DSA and iFlow images were evaluated by junior and senior physicians,who then reported whether iFlow images had supplementary diagnosis value.ResultsiFlow images displayed whole information of lesions more clearly than those of 2D DSA in brain vascular dynamic sequence,including vascular anatomy,hemodynamic changes and tissues perfusions.The evaluation of 2D DSA and iFlow images with junior and senior physicians had statistical difference (x2 =6.032,P=0.014).ConclusionCompared to single DSA,iFlow can facilitate the diagnosis and evaluation of cerebral vascular diseases,especially for junior physicians.
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Forty five patients with acute cerebral infarction were randomized to two groups: in treatment group patients received local subhypothermia and conventional therapy, in control group patients received conventional therapy only. Clinical outcome was assessed by the National Institutes of Health Stroke Scale (NIHSS) on admission and at 7, 14 and 30 d after treatment. Serum neuron specific enolase (NSE), nitrogen monoxide ( NO ) , superoxide dismutase (SOD), interleukin-6 (IL-6 ) and intercellular adhesion molecule-1 (ICAM-1) were detected on admission and at 7,14 d after treatment The study showed that NIHSS scores of treatment group on 14, 30 d were lower than those of control group ( P ＜ 0. 05 ). Serum NSE, NO, IL-6 and ICAM-1 levels significantly decrease; while serum SOD levels increased (P ＜ 0. 05). In conclusion, local subhypothermia therapy can inhibit inflammatory reaction, reduce oxygen free radical formation and improve neurological function in patients with acute cerebral infarction.
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Objective To evaluate the value of MR angiography in thrombolytic therapy of acute ischemic stroke. Methods According to inclusion criteria, 65 patients who also having large vessel occlusion were selected, and they were performed rt-PA treatment (38 patients) and routine treatment (27 patients) within 3-6 hours of onset of symptoms, respectively. Mann-Whitney U test and chi square test were performed to compare the clinical and MR imaging baseline index and the clinical outcome between the two groups respectively. Clinical outcome was assessed after 3 months using a dichotomized modified Rankin scale score.Data were also compared with the combined analysis of the ATLANTIS, ECASS, NINDS rt-PA trials. Resets The difference of clinical outcome in 3 months between the two groups was significant (P < 0. 05) and the median of the two group was 1 and 3, respectively. The ratio of favorable outcome (mRS 0-1) in the two groups was 52. 6% (20/38) and 33.3% (9/27), respectively. Conclusion MR angiography plays an important role in thrombolytic therapy of acute ischemic stroke and it should be used to consummate the conventional inclusion criteria, the patients with large vessel occlusion should be treated by rt-PA.
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Objective To observe the efficacy of arterial thrombolysis treatment in patients with acute cerebral infarction caused by internal carotid artery(ICA),middle cerebral artery(MCA)and vertebrobasilar artery(VBA)occlusion and during different time windows.Methods In the 40 patients with different artery(12 ICA,18 MCA and 10 VBA)occlusions,19 patients with the time windows of 0.05).The rate of better prognosis at 90 d followed up with MRS demonstrated 77.8% in MCA,41.7% in ICA and 30.0% in VBA and there were significant difference among these three groups(all P