静脉内与联合(静脉内和动脉内)溶栓治疗急性缺血性卒中的比较:一项经颅彩色编码多普勒超声引导的先导性研究

作     者：Sekoranja L. Loulidi J. Yilmaz H. R.F.Sztajzel 郭俊 

作者机构：Dr.Neurosonology UnitDepartment of Neurology24rue Micheli-du-Crest1211 Geneva 14Switzerland 

出 版 物：《世界核心医学期刊文摘(神经病学分册)》 (Digest of the World Core Medical Journals.Clinical Neurology)

年 卷 期：2006年第12期

页      面：44-45页

学科分类：1002[医学-临床医学] 100204[医学-神经病学] 10[医学] 

主　　题：溶栓治疗 静脉内 经颅 彩色编码 多普勒超声 

摘      要：BACKGROUND AND PURPOSE-Determine feasibility and safety of intravenous(IV)versus combined(IV-IA [intra-arterial])thrombolysis guided by transcranial color-coded duplex sonography(TCCD).METHODS-Thirty-three patients eligible for IV thrombolysis,within 3 hours of onset of symptoms,with occlusion in middle cerebral artery territory(TCCD monitoring,thrombolysis in brain ischemia [TIBI] flow grade [0-3]),underwent IV thrombolysis(tissue plasminogen activator,0.9 mg/kg).In case of recanalization(modification of TIBI score ≥1)after 30 minutes IV thrombolysis was continued over 1 hour;otherwise,it was discontinued,with subsequent IA *** was determined by TIBI(TCCD)and angiographically by thrombolysis in myocardial infarction(TIMI)flow *** outcome measures were assessed at baseline,24 hours(NIHSS)and 3 months(modified Rankin Scale).RESULTS-In the IV group,10/17 patients(59%)with complete or partial recanalization after 30 minutes had a favorable outcome at 3 months(modified Rankin Scale 0 to 2).TIBI flow grades 3 to 5 after 30 minutes of IV thrombolysis predicted a good prognosis compared with TIBI grades 1to 2(P 0.05).In the combined IV/IA therapy group(no recanalization after 30 minutes),9/16 patients(56%)had a favorable outcome at 3 *** symptomatic intracerebral hemorrhage occurred in each ***-Combined IV-IA versus IV thrombolysis guided by TCCD was feasible and *** after 30 minutes of IV thrombolysis led to a favorable outcome in 59%of the patients,provided TIBI flow grades were of 3 to *** the absence of early recanalization during IV thrombolysis,there was clinical benefit to proceed to IA therapy for a significative proportion of patients(56%).