Endovascular Administration After Intravenous Infusion Of Thrombolytic Agents For The Treatment Of Patients With Acute Ischemic Strokes

Objective Based on imaging, combined intravenous and intra-arterial thrombolytic therapy was made for acute ischemic stroke. To observe recanalization, improvement of neurological assessment of stroke severity,and clinical outcome. To observe the safety and efficacy of endovascular administration after intravenous infusion of thrombolytic agents for the treatment of patients with acute ischemic strokesMethod 14 patients were treated by using tPA. Primary assessment was performed with MR in all patients. Angiographic recanalizationwas classified according to Thrombolysis In Myocardial Infarction (TIMI) grades. Clinical outcome was classified as good for Modifified Rankin Scale(MRS) scores of 0 to 3 and poor for MRS scores 4 to 6.In every patient available, ESS was recorded, bood routine,urine routine, ECG,liver function, renal function, blood sugar, fibrinogen and plasminogen time were examined.Repeat doses were administrated as needed to achieve recanalization or unlil the total dose of tPA (iv and ia doses combined) was 50 mg. The iv infusion of heparin was allowed for 500 IU first and 500 IU/h. Blood pressure , heart rate, ECG were monitored. The iv infusion of tPA weregiven 10 to 25 mg.Results 14 cases, including 11 males and 3 females, aged from 46 to 78.Time to iv and ia treatment was 3.23 0.57h, 5.43 0.68H .Ml segment occluded in 4 cases,M2-3 segment occluded in 2 cases, M3 segment occluded in 1 case.A1-2 segment occluded in 2 cases.C3 segment occluded in 1 case,P| segment occluded in 1 case.the lenticulostriate arteries segment occluded in 3 cases.The incidence of intracranial hemorrhage (unsymptomatic) was 1 of 14.There happened brain stem infarction in 1 case. Complete recanalization were made in 9 cases, and partial recanalization were made in 2 cases; recanalization were made in 1 of 3 cases of the lenticulostriate arteries segment occluded.Conclusion Endovascular administration after intravenous infusion of thrombolytic agents for the treatment of patients with acute ischemic strokes is feasible and safe. Compared with data of literatures, this protocol lead to high recanalization rate, good improvement of neurological assessment,and good clinical outcome. MR imaging is valuable to indicate thrombolysis.