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Central retinal artery occlusion(CRAO), also known as eye stroke, always results in acute and painless visual loss. At present, conservative treatments, such as eye massage, lowering intraocular pressure and vasodilators have little effect on reducing visual loss. Intra-arterial thrombolysis(IAT)has significantly improved prognosis in patients with acute ischemic stroke, thus IAT has been gradually applied in the treatment of CRAO. IAT injects fibrinolytic drugs directly into the ophthalmic artery by a microcatheter, and dissolves the emboli that block the central retinal artery to restore the blood flow of the retina. Theoretically, IAT may be effective for CRAO as what has been found for stroke, but existing clinical studies exhibited inconsistent results. This paper summarizes the feasibility, efficacy, and safety of IAT treatment in CRAO. It will also analyze related factors that affect the prognosis, putting forward potential development directions and providing insights for the further clinical application of IAT.
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Objective:To explore the short-term efficacy and safety of intra-arterial thrombolysis (IAT) in the treatment of retinal artery occlusion (RAO) with the assistance of the rescue green channel in the eye stroke center.Methods:A prospective, interventional, single-center study. Thirty-eight eyes from 38 RAO patients who received IAT treatment in Guangdong Provincial People’s Hospital were enrolled. All the patients were rescued via the green channel in our eye stroke center. Data from comprehensive ocular examinations including best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were collected. BCVA was measured with Snellen chart and converted to the logarithmic minimum angle of resolution (logMAR) unit for statistical analysis. RTVue XR OCTA was used to measure vascular densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary (RPC), and central retinal thickness (CRT). All RAO eyes attempted IAT treatment and 34 eyes were successful. Four eyes failed to complete IAT because of the occlusion of internal or common carotid arteries on the same side with the RAO eyes. Ocular examinations in post-operative 1-3 days were performed with the same devices and methods as those before surgery. Parameters measured before and after surgery include BCVA, VD of SCP, DCP, RPC, and CRT. Data of the green channel collected include the time intervals from onset of RAO to first presentation in local hospitals, and from onset of RAO to our eye stroke center. Comparisons of VD and CRT between the RAO eyes and contralateral healthy eyes were performed with independent samples Mann-Whitney U test; comparisons of VD and CRT in RAO eyes before and after IAT surgery were performed with paired samples Wilcoxon Rank Sum test. Results:Among the 34 RAO patients who had successful IAT surgery, 18 (52.9%, 18/34) were males and 16 (47.1%, 16/34) were females; the mean age was (51.0±12.9) years old. There were 30 and 4 eyes diagnosed as central RAO and branch RAO respectively. The logMAR BCVA before and after IAT surgery was 2.52±0.61 and 2.18±0.85 respectively, and the difference was statistically significant ( Z=-3.453, P=0.002). Before surgery, VD of SCP, DCP and RPC were significantly decreased and CRT was significantly increased in the affected eye compared with the contralateral healthy eyes, with the statistical significance ( P<0.001). Compared with those before surgery, the VD of SCP and DCP were significantly improved after surgery ( Z=-2.523, -2.427; P=0.010, 0.014), while there was no difference in VD of RPC and CRT ( Z=-1.448, -1.454; P=0.150, 0.159). The time interval between onset of RAO and first visit to the hospital was (6.56±6.73) hours; the time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early postoperative period and no cerebrocardiovascular events were observed later. he time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early postoperative period and no cerebrocardiovascular events were observed later. Conclusions:The short-term efficacy and safety of IAT in the treatment of RAO were satisfactory. The rescue time window might be prolonged.
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Objective To analyze the clinical efficacy of transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in the treatment of hepatic artery thrombosis (HAT) after liver transplantation. Methods Clinical data of 9 patients diagnosed with HAT after liver transplantation undergoing transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization were retrospectively analyzed. The incidence of HAT and clinical efficacy of thrombolytic therapy were summarized. The incidence of thrombolysis related complications and clinical prognosis were evaluated. The thrombolytic therapy procedures of typical cases were analyzed. Results HAT was diagnosed at 1-66 d after liver transplantation with a median time of 10 d. The formation site of HAT was found at the anastomosis of the main hepatic artery in 8 cases and at the right branch in 1 case. Upon diagnosis, 9 patients received transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in emergency. The hepatic artery was open during operation in 4 cases and treated with postoperative thrombolytic therapy with indwelling catheter in 3 cases. The opening time for inwelling catheter was 72-96 h. The total successful rate was 7/9. The thrombolysis related complication of abdominal hemorrhage occurred in 1 case after surgery. Three cases died, including 2 cases of liver failure and infection, and 1 case of biliary ischemia and systemic infection at 70 d after interventional therapy. Conclusions Hepatic arterial thrombolysis combined with splenic arterial embolization is an efficacious treatment for HAT after liver transplantation, which can serve as the optimal therapy for patients who are unable to undergo secondary liver transplantation.
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Objective:To investigate the clinical efficacy of mechanical solitaire AB stents thrombectomy combined with intra-arterial thrombolysis in the treatment of patient with acute ischemic stroke.Methods:Fifteen patients with acute ischemic stroke admitted into our hospital from August 2014 to August 2016 were treated with mechanical thrombectomy with solitaire AB stents plus intra-arterial thrombolysis.The National Institutes of Health Stroke Scale score (NIHSS) of all patients were evaluated before and after treatment to compare the clinical efficacy.The prognosis ofpatients between two groups were compared via evaluating modified Rankin score (mRS)and gelasijia coma score (GCS).Results:After mechanical thrombectomy with solitaire AB stents plus intra-arterial thrombolysis treatment,14 patients achieved complete or part recanalization,and 1 patient was terminated treatment due to vital signs instability,and the rate ofrecanalization was 93.3％.The NIHSS score of patients before treatment was 12.93± 4.25,which was much higher than that after treatment (4.33± 1.45,P＜0.05).After follow-up by 3 months,the good mRS scores were obtained in all 18 patients,including 2 patients with mRS score of 2,5 patients with 1,and 8 patients with 0.Additionally,there was no patient with re-obstruction during follow-up period.Conclusion:Mechanical thrombectomy with solitaire AB stents combined with intra-arterial thrombolysis had a good capability and safety in the treatment of patients with acute ischemic stroke.
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Objective To explore the value of dual-source dual-energy CT (DSDE-CT) in differentiating extravasation of iodine contrast agents from secondary hemorrhage after revascularization in acute ischemic stroke. Methods 46 acute ischemic stroke patients following intra-arterial thrombolysis were examined with DSDE-CT within 2 hours after the procedure. Simultaneous imaging at 80 kV/392 mA and 140 kV/196 mA was employed, and then mixed images, virtual unenhanced non-contrast images and iodine overlay maps were calculated. Mixed images alone, as conventional CT, and DUDE-CT interpretations were assessed separately by two radiologists and compared with follow-up CT. Results 6 of 34 patients were negative cases proven by CT without high density, and another 28 cases were proven positive cases with 3 cases of cerebral hemorrhage, 21 cases of contrast agent extravasation, and the remaining 4 cases of combined cerebral hemorrhage and contrast agent extravasation. The sensibility, specificity, positive predictive value, negative predictive value and accuracy of mixed imaging alone in diagnosing hemorrhage was 66.67%, 100%, 1005, 96.15% and 96.43%, while the sensibility, specificity, positive predictive value, negative predictive value and accuracy of hemorrhage with DUDE-CT was 100%, 96%, 75%, 100% and 96.43% . The diagnostic accuracy of superimposed fusion images for intracranial hemorrhage, extravasation of contrast agent and hemorrhage with extravasation of contrast agent was relatively high, and the difference was statistically significant (P < 0.05). The diagnostic accuracy of superimposed fusion images consistent with clinical follow-up was significantly higher (Kappa=0.815),as compared with that of mixed imaging alone (Kappa=0.0.564). Conclusion DUDE-CT has great value in differentiating hemorrhage from iodinated contrast after intra-arterial thrombolysis in acute ischemic stroke.
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Objective To investigate the clinical safety and efficacy of mechanical thrombectomy(MT) with Solitaire stent compared with the selective intra-arterial thrombolysis (IAT) in the treatment of acute cerebral infarction.Methods Totally 82 cases patients with severe acute ischemic stroke caused by middle cerebral artery stenosis from January 2014 to May 2016 in the stroke treatment center of the first people's Hospital in ZunYi city who were applied with the mechanical thrombectomy or the selective intra-arterial thrombolysis was included,and a comparative analysis was conducted on the mTICI rating to assess the interventional recanalization,the NIHSS score after the treatment,bleeding rate,and conditions of neurological functional recovery 90 days after operation.Results There were 42 cases applied with the mechanical thrombectomy (MT group),40 cases applied with the intra-arterial thrombolysis (IAT group).The total effective rate reached 85.70％ in the MT group and 62.50％ in the IAT group,the difference was significant (P ＜ 0.05).Compared with NIHSS score before operation,the score after the treatment showed a decreased trend.And the NIHSS score of MT group was better than that of the IAT group in a week after the treatment (P ＜ 0.05).The bleeding rate was lower in the MT group with statistically significant difference (P ＜ 0.05).Conclusion Compared to IAT,MT can provide broader time window,higher recanalization rate and better outcome in patients with severe acute ischemic stroke.
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PURPOSE: To report two patients who developed central retinal artery occlusion (CRAO) after trauma. CASE SUMMARY: A 26-year-old man complained of severe loss of vision in his left eye after falling and bumping his forehead on a staircase. His visual acuity was light perception in the left eye. Fundus examination revealed edematous white retina and a cherry red spot on the macula. Angiography showed severe stenosis in the initial segment of the ophthalmic artery with ophthalmic arterial embolus. He underwent intra-arterial thrombolysis with a clinical diagnosis of CRAO with ophthalmic artery stenosis. A 57-year-old woman presented with vision loss after falling and striking her face below her right lower eyelid on a wooden stick. Her visual acuity was hand motions in the right eye. Fundus examinations showed white retina with opacity and a cherry red spot on the macula. Fluorescein angiography and optical coherence tomography was performed, and a clinical diagnosis of CRAO was made. CONCLUSIONS: CRAO must be considered when clinically differentiating visual loss after a trauma.
Subject(s)
Adult , Female , Humans , Middle Aged , Angiography , Constriction, Pathologic , Diagnosis , Embolism , Eyelids , Fluorescein Angiography , Forehead , Hand , Ophthalmic Artery , Prunus , Retina , Retinal Artery Occlusion , Retinal Artery , Strikes, Employee , Tomography, Optical Coherence , Visual AcuityABSTRACT
Objective To investigate the relationship between the residual forward blood flow and the therapeutic outcome in patients with acute cerebral infarction after arterial thrombolysis treatment. Methods During the period from January 2009 to December 2013 at authors’ hospital, a total of 40 patients with acute anterior circle cerebral infarction were treated with arterial thrombolysis. The clinical data were retrospectively analyzed. The patients were divided into group A (n=23) when residual forward blood flow and/or collateral circulation were presented, and group B (n=17) if no residual forward blood flow and/or collateral circulation were detected. The NIHSS scores and hemorrhagic transformation state were determined 14 days after the thrombolysis treatment, and the results were compared between the two groups. Results In group A, 21 cases (91.3%) showed complete or partial re- canalization of the infracted vessels, and asymptomatic hemorrhagic transformation was seen in one case. The pre-treatment NIHSS score was 12.69 ± 3.88 and the post-treatment NIHSS score was 6.05 ± 3.25. In group B, complete or partial re-canalization of the infracted vessels was seen in 15 cases (88.2%), asymptomatic hemorrhagic transformation was found in one case and symptomatic hemorrhagic transformation occurred in one case, who died of massive cerebral hemorrhage seven hours after the thrombolysis treatment. The pre-treatment NIHSS score was 13.51 ± 4.19 and the post-treatment NIHSS score was 8.68 ± 5.16. The differences between the two groups were statistically significant (P < 0.05). The obvious effect rate in group A and group B was 68.1% and 43.8% respectively, and the effective rate in group A and group B was 86.3% and 56.3% respectively, indicating that the clinical outcome of group A was much better than that of group B. Conclusion The therapeutic effect of arterial thrombolysis for acute cerebral infarction patients is not only closely related to the time window but also to the residual forward blood flow. The more the residual forward blood flow there is, the better the therapeutic result with less risk of hemorrhagic transformation will be.
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Objective To explore effects of mild hypothermia on early neurological deterioration (END) after main arterial occlusive with intra-arterial thrombolysis. Methods Fifty patients were randomly divided into mild hypothermia and conventional group, to compared the changes of ICP, CVP, MAP, Blood K+, PT, PLT, ScvO2 and NIHSS before- treatment and 24 h and 7 d after- treatment , prognosis and mortality were evaluated by MRS after 90 d. Results (1) Compared with pre-treatment, 7 d NIHSS of mild hypothermia group decreased (P < 0.01); 24 h, 7 d ICP and ScvO2 improved significantly (P < 0.05); 24 h decreased significantly (P <0.05), while 7 d blood K+ showed no differences. (2) Compared with conventional group, mild hypothermia group 7 d NIHSS and 24 h, 7 d ICP and ScvO2 improved significantly (P < 0.05). (3) The CVP, MAP, PT, and PLT showed no difference in two groups before and after-treatment . ( 4 ) Rate of good outcome in mild hypothermia group was significantly higher than conventional group in 90 days (P < 0.01); while the mortality rate showed no difference. Conclusions Mild hypothermia can obviously improve END in stroke with intra-arterial thrombolysise, bring better outcome among survival patients, though can not reduce mortality.
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Objective To study the effect and safety of intra-arterial thrombolysis combined with mechanical ad-juvant in the treatment of acute large artery occlusive infarction of anterior circulation and posterior circulation. Methods Fourty-tow patients were divided into anterior circulation group (24 cases) and posterior circulation group(18 cases). The recanalization rate, NIHSS score (National Institute of Health stroke scale), GCS score ( Glasgow coma score,GCS), BI ( Barthel Index) excellent rate, symptomatic intracranial hemorrhage rate and mortality was analyzed after intra-arterial thrombolysis combined with mechanical aids therapy. Results The anterior circulation group was mainly caused by car-diogenic embolism (15/24, 62.5%) and posterior circulation group was mainly caused by atherosclerosis thrombosis (5/18, 72.2%). The NIHSS score was significantly lower after treatment (8.3±4.9 vs. 8.1±5.7) than before treatment(15.1±5.3 vs. 16.8±7.8)(P=0.001 vs. P=0.001), the GCS score was significantly higher after treatment(13.9±4.4 vs. 12.8±4.2)than be-fore treatment(9.5 ± 3.8 vs. 9.6 ± 3.7)(P=0.001 vs. P=0.021). The symptomatic intracranial hemorrhage rate was signifi-cant higher in anterior circulation group (5/24, 20.8%) than in posterior circulation group (0,0%) (P<0.05). Compared with the anterior circulation group, the recanalization rate trended to increase in posterior circulation group (P=0.830).The symptomatic intracranial hemorrhage rate in anterior circulation group (5/24,20.8%) was significant higher than in pos-terior circulation group (0,0%) (P<0.05), the mortality was similar between these two groups. Conclusions Intra-arterial thrombolysis combined with mechanical adjuvant therapy can improve neurological deficit in acute large artery occlusive infarction and increase the recanalization rate,which is more suitable for the treatment of posterior circulation infarction.
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Objective To observe the cerebral edema occurrence ,evolution and prognosis of intra-arterial thrombolytic recanali-zation in patients with acute ischemic stroke .Methods From October 2010 to October 2012 ,36 patients who underwent the intra-arterial thrombolytic therapy were cerebral recanalization .They were randomly divided into two groups :1-3 h group and >3-6 h group .The alteration of brain edema was observed by cranial CT .Their mRS .NHISS and BI were scaled and recorded before and after intra-arterial thrombolytic therapy .Results After intra-arterial thrombolytic therapy ,the occurrence rate of cerebral edema was 94% ,appeared at the onset of more than 1 hours in all patients .Long-term follow-up showed ,cerebral edema location appeared obvious cerebromalacia .Cerebral edema and clinical outcome had not significant difference between 1-3 h group and 3-6 h group . Conclusion Cerebral edema and loss of cerebral tissue occurred almost inevitability in patients who received intra-artery thromboly-sis and recanalized their cerebral artery .It indicates that good local circulation and general condition may be favorable factors that can gradually reduce brain edema .
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Objective To evaluate the efficacy and safety of intra-arterial thrombolysis with recombinant tissue-plasminogen ac-tivator(rt-RA) for treatment of acute cerebral infarction (ACI) .Methods The randomized controlled trials (RCT ) of intra-arterial thrombolysis with rt-PA for treatment of ACI were selected from Cochrane Library ,Medline ,Embase and CBM by the computer re-trieval .A meta analysis of the data were analyzed by using RevMan 5 .1 software .Results A total of 473 patients in 9 selected RCTs were involved in the systematic review .Meta-analysis results disclosed suggested that the effectiveness of intra-arterial thrombolysis treated ACI group was better than that of intravenous thrombolysis group [RR= 1 .26 ,95% CI(1 .09 ,1 .45) ,P=0 .002] .No difference was observed between the two groups in intracranial hemorrhage and mortality rate .Conclusion The current evidence showed that ,the clinical effect of intra-arterial thrombolysis with rt-PA for treatment of ACI was obviously superior to that of intravenous thrombolysis ,but the result still needs to be confirmed by large-sample RCTs .
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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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Among the many advances in acute ischemic stroke (AIS) management, thrombolysis with intravenous (IV) tissue plasminogen activator (tPA) within 3 hours after symptom onset has been the only approved pharmacological therapy in AIS. However, IV administration of tPA has many limitations in clinical practice, and the proportion of eligible patients remains quite low. Many clinical trials have attempted to overcome this by increasing the therapeutic time window and enhancing the efficacy of reperfusion by the intra-arterial (IA) approach with novel mechanical devices. In addition, the application of new thrombolytic agents and identification of suitable thrombolytic candidates by multimodal brain imaging is another field of active research in thrombolytic therapy. We reviewed AIS management, focusing on thrombolysis with IV therapy, IA therapy, and IV-IA bridging therapy.
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Humans , Fibrinolytic Agents , Neuroimaging , Reperfusion , Stroke , Thrombolytic Therapy , Tissue Plasminogen ActivatorABSTRACT
In teaching of intra-arterial thrombolysis of ischemic stroke, introducing the method of problem-based learning ( PBL ) to improve the students' learning initiative and stimulate the students' interest in search of knowledge, and guide students to form scientific clinical thinking. Through further participation in surgery, promoting the combination of theory and practice. PBL can help to improve students' ability to analyze and solve problems related to intra-arterial thrombolysis of ischemic stroke.
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According to the "drip and ship" concept, patients who are not responsive to intravenous tissue plasminogen activator (IV-tPA) at a community hospital may be candidates for subsequent intra-arterial (IA) thrombolysis at a comprehensive stroke center. We elucidated the efficacy and safety of combined IV/IA thrombolysis via the drip and ship approach. We retrospectively reviewed patients with acute ischemic stroke who underwent combined IV/IA thrombolysis between March 2006 and June 2009. The patients were divided into two groups (inside hospital IV-tPA vs. outside hospital IV-tPA). We compared the short- and long-term clinical outcome, recanalization rate, intracranial hemorrhage after the procedure, and onset to treatment time between the two groups. A total of 23 patients with inside hospital IV-tPA and 10 patients with outside hospital IV-tPA were included. The mean pre-treatment National Institutes of Health Stroke Scale (NIHSS) scores were 15.8 and 17.5, respectively. Baseline characteristics were not significantly different between the two groups. The NIHSS score at 1 week and favorable outcome rate (modified Rankin Scale < or =2) 3 months after the procedure were not significantly different (p=0.730 and p=0.141, respectively). The rate of recanalization and intracranial hemorrhage were not significantly different (p=0.560 and p=0.730, respectively). The onset to IA thrombolysis time was also not significantly different (222.7 vs. 239.3 minutes, p=0.455). Our results suggest that initiation of IV-tPA in a community hospital with rapid transfer to a comprehensive stroke center for subsequent IA thrombolysis can be a safe and feasible therapeutic option in acute stroke management.
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Humans , Hospitals, Community , Intracranial Hemorrhages , Retrospective Studies , Ships , Stroke , Tissue Plasminogen ActivatorABSTRACT
According to the "drip and ship" concept, patients who are not responsive to intravenous tissue plasminogen activator (IV-tPA) at a community hospital may be candidates for subsequent intra-arterial (IA) thrombolysis at a comprehensive stroke center. We elucidated the efficacy and safety of combined IV/IA thrombolysis via the drip and ship approach. We retrospectively reviewed patients with acute ischemic stroke who underwent combined IV/IA thrombolysis between March 2006 and June 2009. The patients were divided into two groups (inside hospital IV-tPA vs. outside hospital IV-tPA). We compared the short- and long-term clinical outcome, recanalization rate, intracranial hemorrhage after the procedure, and onset to treatment time between the two groups. A total of 23 patients with inside hospital IV-tPA and 10 patients with outside hospital IV-tPA were included. The mean pre-treatment National Institutes of Health Stroke Scale (NIHSS) scores were 15.8 and 17.5, respectively. Baseline characteristics were not significantly different between the two groups. The NIHSS score at 1 week and favorable outcome rate (modified Rankin Scale < or =2) 3 months after the procedure were not significantly different (p=0.730 and p=0.141, respectively). The rate of recanalization and intracranial hemorrhage were not significantly different (p=0.560 and p=0.730, respectively). The onset to IA thrombolysis time was also not significantly different (222.7 vs. 239.3 minutes, p=0.455). Our results suggest that initiation of IV-tPA in a community hospital with rapid transfer to a comprehensive stroke center for subsequent IA thrombolysis can be a safe and feasible therapeutic option in acute stroke management.
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Humans , Hospitals, Community , Intracranial Hemorrhages , Retrospective Studies , Ships , Stroke , Tissue Plasminogen ActivatorABSTRACT
Approximately 20%-30% of the patients with acute ischemic stroke do not have an angiographically demonstrable arterial occlusion. This article reviews the possible explanations for the absence of angiographically documented occlusion, the risk and the occurrence rate of cerebral infarction, the prognosis, and the effectiveness as well as the safety of thrombolytic therapy.
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Objective:To evaluate the efficacy and safety of selective intra-arterial thrombolysis with urokirmse for acute cerebral infarction.Methods:Thirty-eight patients with acute cerebral infarction were treated by selective intra-arterial thrombolysis with urokinase within 6 hours of onset.Head CT seans were performed immediately and 24 hours after the procedures to find out whether intracerebral hemorrhage(ICH)had occurred.The activities of daily living and functional outcome of the patients were evaluated by the Barthel Index(BI)and the National Institutes of Health Stroke Scale(NmSS).Results:Of the 38 patients,21 achieved complete recanalization,8 achieved partial recanalization,3 occurred symptomatic intracranial hemorrhage,and l died.At day 90,22 patients had a favorable outcome(BI≥90),11(50≤BI＜90)had a better outcome,and 4 had a worse one(BI＜50);at 6 months,24 patients had a favorable outcome,9 had a better outcome.and 4 had a worse one.The NIHSS scores at day 14 after the procedures were significantly superior to the levels betore the procedures(12.68±7.43 versus 15.38±4.32,P＜0.011.Conclusions: Intra-arterial thrombolysis with urokinase can recanalize the occluded vessels and improve the acute clinical symptoms and long-term prognosis of patients.
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Objectire:To explore and evaluate the predictors for the prognosis of acute besilar artery occlusion(BAO)and the clinical efficacy of intra-arterial thrombolysis and stenting for BAO.Methods:Intra-arterial thrombolysis was administered with recombinant tissue plasminogen activator or urokinase in 52 patients with BAO within 3 to 48 hours.Stenting was performed in patients whose partial recanalization of residual stenosis＞50%after the thrombolysis.National Institutes of Health Stroke Scale(NIHSS)score was measured before the procedure,and the modifled Rankin scale(mRS)score was obtained at 3 months after the procedure.The clinical data were evaluated with the multivariable stepwise logistic regression analysis and Fisher's exact test.Results:Complete recanalization achieved in 24 patients(46.2%),partial recanalization in 16 patients(30.7%),and non-recanalization in 12 patients(23.1%).mRS scores:22 patients(42.3%)had a favorable outcome,32 survived(61.5%),and 20 died (38.5%).The prognosis of BAO was significantly correlated with the NIHSS score(P＜0.01),therapeutic time window (P ＜0.05) and recanalization level (after the thrombolysis and stenting)(P＜0.01 );the good recanalization after the intra-arterial thrombolysis was significantly correlated with the NIHSS score (P ＜0.01) and therapeutic time window (P ＜0.05).Multivariate analysis showed that the NIHSS score ＜ 14 (P ＜ 0.01 ) and good recanalization could independently predict the favorable prognosis of BAO.Conclusions:The NIHSS score ＜ 14 and good recanalization were the independent predictors for good prognosis of BAO.The rapid and timely treatment of BAO with intra-arterial thrombolysis and stenting is a safe and effective measure.