多模式MRI指导下不同时间窗脑梗死静脉溶栓血管再通临床研究

The study on cerebral artery recanalization after multi-mode MRI based intravenous thrombolysis in patients with stroke in different therapy time window

目的探讨多模式磁共振(MRI)指导下不同时间窗脑梗死rt-PA静脉溶栓后血管再通情况及其对预后的影响。方法收集发病12h内脑梗死患者行头颅MRI检查,符合静脉溶栓标准126例,治疗前MRA显示血管TIMI分级≤2分患者95例,其中4.5h组64例,4.5~12h组31例,观察两组患者血管再通的情况,分析血管再通与预后的关系。结果治疗后24h复查MRA显示4.5h组再通42例(42/64,65.62%),4.5~12h组19例(19/31,61.29%),两组患者再通率差异无统计学意义;血管再通与梗死部位有关,颈内动脉再通1例(1/5,20%);大脑中动脉M1段再通6例(6/12,50%);M2段及分支再通45例(45/61,73.77%);椎基底动脉再通9例(9/17,52.94%);血管再通组和未通组90d NIHSS评分及临床结局有显著性差异。3例症状性脑出血,治疗前NIHSS评分平均16分,TIMI分级均0级,患者平均年龄75±3.6岁,大于总体平均年龄69±10.2岁(P<0.05)。结论多模式MRI指导下的脑梗死将时间窗扩大到12h内静脉溶栓治疗安全有效,血管再通良好;血管早期再通可改善临床预后,血管再通的情况将来可作为监测预后的指标;症状性脑出血更可能发生于高龄、血管闭塞严重病情较重的患者。

Objective To explore the cerebral artery recanalization and its influence on prognosis after multi-mode MRI based rt-PA intravenous thrombolysis in patients with stroke in different therapy time window. Method With the emergent brain MRI scaning who had been diagnosed as cerebral infarction within 12 hours of acute stroke symptom onset,one hundred and tweenty six cases were confirmed according with the standard of thrombolysis. Before treatment,MRA scaning of ninety-five cases showed that vascular TIMI grade were 2 grades or less,including sixty-four cases in group of within 4.5 hours, thirty-one cases in group of within 4.5？12 hours.Observe the artery recanalization of the two groups and study the relationship between artery recanalization and the prognosis. Results 24h after treatment,repetitive cranial MRA showed that vessel re-flowing was seen in forty-two cases within 4.5 hours group（42/64,65.62%）and nineteen cases within 4.5~12 hours group（19/31, 61.29%）.There were no significant difference between two groups in the rate of vascular thrombolytic recanalization. Recanalization was closely related to the location of cerebral infarction.Recanalization of ICA territory was achieved in 1 cases （1/5, 20% ） , MCA-M1 in 6 cases （ 6/12, 50% ） , MCA-M2 and its branches in forty-five cases （ 45/61, 73.77% ）, and vertebral-basilar artery in 9 cases（9/17,52.94%）. There were significant difference between two groups of the reopened and unopened in NIHSS score and MRS scores of 90 days after thrombolysis therapy.There were 3 cases sufferd from symptomatic intranial hemorrhage whose NIHSS scores averaged 16 points, TIMI grade was 0 grade, average age were 75±3.6 older than the overall average age 69±10.2（ P〈0.05）.Conclusion Our study suggested that multi-mode MRI-based rt-PA intravenous thrombolysis with broadened therapeutic window is safe and effective in patients who had been diagnosed as cerebral infarction within 12 hours of acute stroke symptom onset.Early vascular recanalization can improve clinical outcomes.Analysis on recanalization after thrombolysis therapy is a useful evaluation of outcome of cerebral infarction patients.Symptomatic cerebral hemorrhage is more likely to occur in older age, more serious vascular occlusion patients.