ABSTRACT
BACKGROUND AND PURPOSE: Combined intravenous (IV) and intra-arterial (IA) thrombolytic therapy may be faster and easier to initiate than monotherapy, and its recanalization rate may be better as well. The sequential combination of recombinant tissue plasminogen activator (rTPA) and urokinase (UK) has synergistic and complementary effects on clot lysis. We prospectively evaluated the effectiveness and safety of sequential combination of IV rTPA and IA UK in acute ischemic stroke. METHODS: IV rTPA was administered to patients with acute stroke within 3 hours of onset. Those whose condition had not improved at the end of rTPA infusion were further treated with selective IA UK. We evaluated baseline and 30-day National Institutes of Health Stroke Scale (NIHSS) scores and 90-day modified Rankin Scale scores. RESULTS: Thirty patients were initially treated with IV rTPA; 24 were further treated with IA UK. Four patients who had rapid reocclusion following initial successful IA therapy received IV abciximab. Fourteen of 24 patients who underwent angiography had an effective perfusion state of Thrombolysis in Myocardial Infarction grade 3 flow. Median baseline and 30-day NIHSS scores were 18 and 2, respectively. Eighteen patients improved to a modified Rankin scale score of 0 or 1 after 90 days. Symptomatic hemorrhage developed in two patients. CONCLUSION: The strategy of using conventional-dose IV rTPA and the sequential combination of IA UK in patients without an early clinical response to IV treatment was safe and feasible. This strategy achieved high complete arterial recanalization rates and good functional outcomes.
Subject(s)
Cerebral Infarction/drug therapy , Fibrinolytic Agents/administration & dosage , Intracranial Embolism/drug therapy , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/administration & dosage , Urokinase-Type Plasminogen Activator/administration & dosage , Abciximab , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/adverse effects , Cerebral Angiography , Cerebral Hemorrhage/chemically induced , Cerebral Infarction/diagnostic imaging , Drug Therapy, Combination , Female , Fibrinolytic Agents/adverse effects , Follow-Up Studies , Humans , Immunoglobulin Fab Fragments/administration & dosage , Immunoglobulin Fab Fragments/adverse effects , Injections, Intra-Arterial , Injections, Intravenous , Intracranial Embolism/diagnostic imaging , Male , Middle Aged , Neurologic Examination/drug effects , Recurrence , Retreatment , Tissue Plasminogen Activator/adverse effects , Urokinase-Type Plasminogen Activator/adverse effectsABSTRACT
We report a hemodynamical assessment of the blood turnover pattern as well as the imaging of cavernous hemangioma in a cavernous sinus using time-resolved contrast enhanced 2D projection MRA, also known as MR-DSA, and conventional digital subtraction angiography (DSA), before and after radiotherapy. MR-DSA showed very fast dynamical images of a contrast turnover pattern and was well matched with the findings obtained from DSA. MR-DSA is a non-invasive study, and can replace DSA in examining a vascular tumor for the initial work-up and follow-up examination.
Subject(s)
Angiography, Digital Subtraction/methods , Cavernous Sinus/diagnostic imaging , Hemangioma, Cavernous/diagnostic imaging , Hemodynamics , Female , Humans , Magnetic Resonance Angiography , Middle AgedABSTRACT
The authors evaluated the reducibility of cervical disk herniation at magnetic resonance (MR) imaging performed with the patient in cervical traction. After the acquisition of neutral-state images, cervical traction images were obtained in 29 patients and seven healthy volunteers while they wore a portable intermittent traction device. During traction, all volunteers and 21 patients had a substantial increase in the length of the cervical vertebral column. The disk herniation was completely resolved in three patients and partially reduced in 18. The reducibility of cervical disk herniation can be evaluated at MR imaging performed during cervical traction.
Subject(s)
Intervertebral Disc Displacement/therapy , Magnetic Resonance Imaging , Traction/instrumentation , Adult , Case-Control Studies , Cervical Vertebrae , Female , Humans , Intervertebral Disc Displacement/diagnosis , MaleABSTRACT
We report the hemodynamic assessment in a patient with cerebral arteriovenous malformation using time-resolved magnetic resonance angiography (TRMRA), a non-invasive modality, and catheter-based digital subtraction angiography (DSA), before and after embolization. Comparison of the results showed that TR-MRA produced very fast dynamic images and the findings closely matched those obtained at DSA. For initial work-up and follow-up studies in patients with vascular lesions, TR-MRA and DSA are therefore comparable.
