RESUMO
Thrombolysis is the most effective treatment of acute ischemic stroke that increases the proportion of patients with good clinical outcome. Selective intra-arterial thrombolysis (IAT) can be used in a wider therapeutic window (up to 6-8 hours) under the angiographic control with tailoring of fibrinolytic dose. The results of IAT by a recombinant plasminogen activator in 2 patients are presented. Patient 1, male, 55 years old, with M1 cerebral middle artery (CMA) occlusion and with NIHSS score 13 on admission was treated by IAT after 7 hours of stroke onset. Recanalization was observed 40 minutes after IAT started. The NIHSS score was 8 after IAT. Patient 2, female, 64 y.o., with NIHSS score 20 on admission and C7 internal carotid artery and M1 CMA occlusion was treated by IAT. Recanalization was observed 60 minute after the beginning of IAT, with NIHSS score being decreased to 14. These clinical cases demonstrate the high efficacy of intra arterial thrombolysis in ischemic stroke patients.
Assuntos
Isquemia Encefálica , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Fibrinolíticos/uso terapêutico , Infarto da Artéria Cerebral Média , Embolia Intracraniana , Doença Aguda , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/etiologia , Angiografia Cerebral , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/tratamento farmacológico , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/tratamento farmacológico , Embolia Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
Intravenous recombinant tissue plasminogen activator (rt-PA) is an approved and effective treatment for acute ischemic stroke within 3 hours of symptoms onset. The results of the first-ever implementation of the thrombolysis in the Russian Federation are presented. Fourteen stroke patients received rt-PA in dose of 0.9 mg/kg (10% as a bolus during 1 minute followed by infusion), the mean "door-to-needle" time was 50 +/- 23.6 min. The thrombolysis resulted in the clinical improvement by the end of the first day after stroke onset in 9 (64.2%) patients, with a dramatic regress of neurological deficit (the decrease of the NIHSS scores = 4) in 3 (21.4%) of them. Hemorrhagic transformation was observed in 6 (42.8%) patients, however in 5 cases it was asymptomatic and was found only in the repeated CT study to the end of the first day. Three months after stroke onset, 7 (50%) patients scored 0-1 on the modified Rankin scale, 1 patient had 4 scores and 1 patient died. Thus the thrombolysis can change the stroke management and significantly improves the outcome.
