多模式MRI指导下动脉溶栓治疗急性缺血性脑卒中

Multimode MRI-base arterial thrombolysis in acute ischemic stroke

目的:评价发病4.5～9h、MRI上有PWI/DWI不匹配、且MRA有责任血管闭塞或重度狭窄的急性缺血性卒中患者动脉溶栓(IAT)的疗效及安全性。方法:回顾性分析发病4.5～9h、MRI上有PWI/DWI不匹配、且有责任血管闭塞或重度狭窄的急性缺血性卒中患者48例,分为IAT组22例及对照组26例,比较其症状性出血率及3个月mRS。结果:IAT组与对照组症状性出血率为9.1%(2/22)与3.8%(1/26),P=0.454。IAT组结局良好,3个月mRS 0～2者占59.1%(13/22),多于对照组30.8%(8/26),P=0.049。结论:对于时间窗为4.5～9h、MRI上有PWI/DWI不匹配、且MRA上有责任血管闭塞或重度狭窄的急性缺血性卒中患者,组织型纤溶酶原激活剂(rt-PA)IAT可提高血管再通率,改善预后。

Objective： To evaluate the efficacy and safety of intra-arterial thrombolysis within 4.5 to 9 hours of ischemic stroke onset in patients with perfusion/diffusion mismatch on MRI. Methods： A retrospective analysis was performed of 48 patients treated between Dec 2005 and Dec 2010, which were divided into 2 groups according to whether accept intra-arterial thrombolysis. Demographics, clinical, and radiographic presentation and outcomes were studied. Results.. All patients were divided into intraarterial thrombolysis group （IAT group, n =22） and control group （ n =26）. The 2 groups had similar demographics,clinical, and radiographic presentation. The symptomatic intracranial hemorrhage （sICH） rate was 9.1 % （2/22） in IAT group, 3.8 （1/26） in control group, P =0. 454. Favorable 90-day clinical outcome （modified Rankin scale （mRS） ：0 to 2 score） was found in 59.1% （13/22） of IAT group and 30.8% （8/26） of control group, P =0. 049. Conclusion.. Intra-arterial thrombolysis can improve the clinical outcome of the acute ischemic stroke patients within 4.5 to 9 hours of ischemic stroke onset and with perfusion/diffusion mismatch on MRI.