Intra-arterial thrombolysis with urokinase in acute cerebral infarction based on computed tomography perfusion imaging within a 6-9 h window: an efficacy and safety analysis
10.3760/cma.j.issn.1671-8925.2013.11.005
- VernacularTitle:CT灌注指导下尿激酶动脉溶栓治疗6～9h急性脑梗死的疗效及安全性分析
- Author:
Qi-Lin MA
1
;
Sui-Jun TONG
;
Yi-Dan ZHANG
;
Han-Shui CHEN
;
Bin JIANG
;
Min BI
Author Information
1. 361003厦门,福建医科大学第一临床医学院神经内科,厦门大学附属第一医院神经内科
- Keywords:
Acute cerebral infarction;
Intra-arterial thrombolysis;
Urokinase;
Computed tomography perfusion imaging;
Ischemic penumbra
- From:
Chinese Journal of Neuromedicine
2013;12(11):1101-1105
- CountryChina
- Language:Chinese
-
Abstract:
Objective To determine the safety and efficacy of intra-arterial urokinase in the treatment of acute cerebral infarction (ACI) patients with computed tomography perfusion-based selection within a 6-9 h window.Methods Fifty-two ACI patients,with computed tomography perfusion imaging (CTPI) identifying thresholds for salvageable penumbra,were randomly assigned to intra-arterial thrombolysis with urokinase (group A) and conventional anti-platelet aggregation (group B) within a 6-9 h window.Whole brain digital subtraction angiography (DSA) was done at pre-and post-treatment to observe the recanalization of occlusive vessels in group A.The National Institutes of Health Stroke scale (NIHSS) 24 h and 7 d after treatment,and modified Rankin Scale (mRS) and Barthel Index (BI) 90 d after treatment were used to evaluate the efficacy.Results In group A,15 patients showed successful recanalization (thrombolysis in myocardial infarction [TIMI] index:grade Ⅲ in 9 and grade Ⅱ in 6) and 12 patients showed unsuccessful recanalization (TIMI index:grade Ⅰ in 6 and grade 0 in 6) with a successful recanalization rate of 55.56％.More obvious NIHSS improvement 24 h and 7 d after treatment in group A was observed than that in group B (P＜0.05),and more patients with favorable outcomes based on mRS and BI in group A were noted than those in group B (P＜0.05).In addition,the incidence of cerebral hemorrhage within 24 h of treatment between the two groups was similar (P＞ 0.05).Conclusions Intra-arterial thrombolysis with urokinase is safe and effective for ACI patients within a 6-9 hour window under the guidance of CTPI.
