The Infarction Of Intravenous Thrombolysis With Urkinase And Super Selective Arterial Thrombolysis For Acute Cerebral Infarction

Research objective:To discuss the effectiveness and security of treating acute cerebral infarction with urokinase intravenous thrombolysis and super-selective intra-arterial thrombolysis, as well as the key factors influencing the long-term regression and prognosis; to analyze and compare the clinical effects of intravenous thrombolysis and intra-arterial thrombolysis; and to provide theoretical basis for the appropriate application of treating intravascular thrombolysis.Method:According to the inclusion standard,75cases of treating acute cerebral infarction with urokinase and thrombolysis in our hospital from May2010to May2012were collected, in which there were54cases of intravenous thrombolysis and21cases of intra-arterial thrombolysis. For the intravenous thrombolysis group, one million U (weight≤50kg) or1.5million (weight>50kg) urokinase was dissolved in100ml or150ml normal saline, and it should injected with intravenous drip within half an hour. For the intra-arterial thrombolysis group, arteria femoralis was punctured under local anesthesia with improved Seldinger method, the6F artery sheath was placed in the arteria femoralis,5F Pigail catheter (Cordis PIG, America) and5F Vertebral (Cordis VER135e, America) were applied, complete cerebral angiography was carried out with digital subtraction angiography (American GE Company) for finding out the offending occlusive blood vessel. And then, microwire (Transend, American Boston Scientific) and microcatheter (Excelsior-10Boston Scientific, America) were sent to the vascular occlusion by6F guiding catheter (Cordis ENVOY, America), the microwire drove microcatheter through the occlusion, and then radiography was controlled manually to learn about the far-end of occlusive blood vessel. Later, the head end of microcatheter was placed in the thrombogenesis for thrombolysis after urokinase was injected in urokinase, and sacculus or support (Solitaire EV3) could be applied during the surgery when necessary for thrombus fragmentation or thrombectomy. In time of thrombolysis,0.1million U urokinase would be injected in the micro pump of microcatheter (finished within5minutes), and then0.3to0.5U urokinase would be dissolved in normal saline for applying micro pump constantly (pumping speed about10000U/minute). During the thrombolysis process, the manual-controlled thrombolysis was disconnected for observing the thrombolysis, and the terminal of thrombolysis was the recovery of revascularization or urokinase reaching one million U. At the beginning of cerebral angiography, heparinization should be conducted with intravenous injection of heparin. The first amount should be2/3mg/kg, and then it should be added every hour, and the dose was about half of the previous amount, until it was10mg. After the surgery, intracranial pressure was decreased, free radical was scavenged, blood glucose was reduced and platelet aggregation was resisted. After discharging from the hospital, the patients would be visited through telephone or outpatient follow-up. It was scored with NIHSS about2h,24h and14d after the surgery for evaluating the short-term efficacy of the two treatment methods. After9months, modified Rankin Scake (mRS) was applied for scoring, in which0-2was good regression group,3-6was poor regression group, and it was applied for evaluating the recovery of neurological function with thrombolytic therapy, namely the long-term prognosis of the patient. After the surgery, the intracranial hemorrhage within two days and death rate within three months were applied for evaluating the security of thrombolysis.Results:1. Intravenous thrombolysis group:before thrombolysis,2h after thrombolysis,24h after thrombolysis,14d after thrombolysis, the NIHSS score decreased gradually, and the difference of each group was significant (p<0.05). After9months, according to mRS scores, favorable prognosis was about46.29%, unfavorable prognosis was53.71%, intracranial hemorrhage was5.55%, and death rate was11.11%.2. Intra-arterial thrombolysis group:before thrombolysis,2h after thrombolysis,24h after thrombolysis,14d after thrombolysis, the NIHSS score decreased gradually, and the difference of each group was significant (p<0.05). After9months, according to mRS scores, favorable prognosis was about76.19%, unfavorable prognosis was24.81%, intracranial hemorrhage was4.76%, and death rate was4.76%. The successful recanalization rate was47.62%, and prognosis was favorable.3. After thrombolysis, the NIHSS score of thrombolysis was smaller than that of intravenous thrombolysis, and the difference of the two groups was significant (p<0.05). The prognosis was more favorable in the intra-arterial thrombolysis group when compared to the intravenous thrombolysis, but there were no differences in intracranial hemorrhage and death rate.Conclusion:For the treatment of acute cerebral infarction with urokinase intravenous thrombolysis and super-selective intra-arterial thrombolysis, both can promote the recovery of neural functional recovery with positive and relatively secure curative effect. As for the treatment of acute cerebral infarction with super-selective intra-arterial thrombolysis, if the revascularization is successful is a significant index for judging the prognosis of intra-arterial thrombolysis. Compared to the urokinase intravenous thrombolysis, more and more studies have proved that the treatment of acute vascular occlusion, such as internal carotid, middle cerebral artery M1section, etc. with super-selective intra-arterial thrombolysis achieves better clinical effect, and it will not increase the death rate. Meanwhile, there are no differences in the security of the two methods. The establishment of unobstructed green channel for acute stroke, as well as the standardization of treatment process and methods, will improve the success rate of treating acute cerebral infarction and reduce the death rate and disability rate.