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Objective To evaluate the efficacy and safety of combined intravenous(Ⅳ)and intra-arterial(IA)thrombolysis in patients with acute ischemic stroke.Methods A prospective and open-label trial was performed on 40 patients with acute ischemic stroke in the carotid artery system within 3 hours of symptom onset,admitted to our hospital from May 2005 to February 2009; these patients were treated with recombinant tissue plasminogen activator(rt-PA)by a combined Ⅳ and IA thrombolysis approach.The percentage of favorable prognosis,incidence of symptomatic intraeranial haemorrhage(SICH)and fatality rate in these patients were compared with those research results from foreigners having large samples.Results According to the results of DSA,recanalization rate (grade-2 or-3 in the Thrombolysis in Cerebral Infarction[TICI]scale)after Ⅳ thrombolysis was 25％(10/40),rate of serious cerebrovascular stenosis was 7.5％(3/40),including 2 patients with stenosis of the internal carotid artery(ICA)and 1 with stenosis of the middle cerebral artery(MCA),and rate of vascular occlusion was 67.5％(27/40),including 9 patients with ICA occlusion and 18 with MCA occlusion.Twenty-four patients adopted combined Ⅳ and IA thrombolysis approach after 180-390 min(mean[304±61]min)of stroke onset,and their recanalization rate was 79.2％(19/24).Re-infarction rate was 7.5％(3/40).Three months after the thrombolysis,percentage of good functional outcomes(modified Rankin Scale[mRS])scores:0-2)was 60％(24/40),which had significant differences as compared with that with NINDS placebo treatment(27.2％[85/312],P＜0.05); percentage of good functional outcomes(NIHSS score ≤ 1)was 52.5％(21/40),which had significant differences as compared with that of groups with NINDS rt-PA treatment(31％[97/312]),NINDS placebo treatment(20％[62/312])and interventionalmanagement of stroke(IMS,27.5％[22/80]),P＜0.05); SICH was noted in 2.5％(1/40)and fatality in 10％(4/40)accepted thrombolysis,and no significant differences were noted as compared with those in groups with NINDS rt-PA treatment,NINDS placebo treatment,emergency management of stroke EMS and IMS (P＞0.05).Conclusion Combined Ⅳ and IA thrombolysis is an effective and safe new method in treating patients with acute ischemic stroke by providing good vascular recanalization rate and good clinical outcomes.
RESUMO
<p><b>OBJECTIVE</b>To evaluate the significance of cerebral protection applied at carotid endarterectomy (CEA) at perioperation, intraoperation, and postoperation.</p><p><b>METHODS</b>Thirty patients underwent CEA with application of cerebral protection at perioperation, intraoperation, and postoperation in our hospital from January 2002 to August 2005. Perioperative carotid Doppler ultrasound and computed tomography angiography (CTA) were applied in 29 patients and carotid angiography applied in only one patient. The key methods of intraoperative cerebral protection included general anaesthesia, selective shunting, monitoring of transcranial Doppler, and careful manipulation. The methods of postoperative cerebral protection included leaving tracheal cannula and brain ice-bag, maintaining normal blood pressure, and applying dehydrant under guidance by monitoring of transcranial Doppler.</p><p><b>RESULTS</b>Among all the 30 patients, shunts were used in 10 patients (33%), and angioplasty by patch was applied in 17 patients (57%). No cranial nerve-associated complications or death was documented.</p><p><b>CONCLUSION</b>Application of cerebral protection at CEA at perioperation, intraoperation, and postoperation can effectively prevent the occurance of cranial nerve-associated complications.</p>