RESUMO
Objective To evaluate the effect and safety of intravenous (IV) thrombolysis, intra-arterial (IA) thrombolysis and mechanical adjuvant intra- arterial thrombolysis (IA + MA) in treating cardiogenic cerebral embolism. Methods A total of 66 patients with cardiogenic cerebral embolism were randomly divided into IV group (n = 25), IA group (n = 18), IA + MA group (n = 23). The artery recanalization rate, NIHSS score, GCS score, BI excellent rate, symptomatic intracranial hemorrhage rate and mortality after different thrombolytic therapies were determined. The results were compared between each other among the three groups. Results In all three groups both the post-treatment NIHSS score and GCS score were significantly improved when compared with pre-treatment ones (P < 0.05). In IA + MA group the artery recanalization rate was 78.3%(18/23) and the BI excellent rate was 40%(10/25), which were significantly higher than those in IV group (P < 0.05). The symptomatic intracranial hemorrhage rate in IA group was 5.6%(1/18), which was strikingly lower than that in IV group (32%, 8/25). Analysis of the causes showed that the artery recanalization rate in patients with valvular heart disease or cardiac myxoma was rather lower, but the intracranial hemorrhage rate and mortality in these patients were much higher. Conclusion Thrombolytic therapy can improve neurological deficit in cardiogenic cerebral embolism, and the therapeutic effect of mechanical adjuvant intra- arterial thrombolysis is definitely better.