Clinical Control Study On The Treatment Of Intra-arterial And Intravenous Thrombolysis In Acute Cerebral Infarction

Stroke is a common and frequently encountered disease which hasthreatened human being?ˉs health and life severly. As the average age ofhuman being has extended, more people get this disease. The numberof people who died of this disease ranks the first three in the reasons ofdeath in China;on some regions, it even ranks the first place. So howto prevent and cure this disease is the question which the medical staffconcern and want to study. Especially the cerebral arterial thrombosisis the study emphasis of neuro-internal medicine since it has a higherfatality rate, mutilation rate and recurrence rate. There existingsemidarkness bond around the cerebral infarction tissue is the basis ofmodern therapy of cerebral arterial thrombosis. Though the earlyaffection center has been the unreversible damage, to recover the bloodof semidarkness bond can salvage the brain tissue which hasn?ˉt beennecrotic and only has some function change. So the revascularizationis the most reasonable treatment. The puopose of thrombolysistreatment of acute arterial occlusion is to urge the obstructive bloodvessel to open again early so as to save the reversible nerve cell. Totake thrombolysis treatment as soon as possible is a energetic method.It still has contention that which is the better one between arterythrombolysis and vein thrombolysis. There are different reports aboutthe findings of different thrombolysis treatment. To synthetize manysmall samples, the results of clinical test show that early thrombolysistreatment has significant therapeutic efficacy. But there were littleclinical control study of those two medications and there still existeddifferent opinions about them. This study reviews the clinical datas of91 acute cerebral infarction patients who were taken thrombolysistreated in 6 hours of morbility between 2000 to 2006 in Ji Linelectricity hospital.Method of the study: Treat 39 patients with the therapy ofintravenousdrip of 250ml normal sodium mixed with 1,000,000Uurokinase to take the thrombolysis, as the control group. 52 patientswere anesthetized locally with lidocaine through femoral arterypuncted according to the Seldinger Method, and then insert the 6Fsheath to heparinize the whole body, place 5Fcatheter into hibateralarteria carotis communis, arteria carotis interna, arteria vertebralis totake the brain angiography, and identify the coherent vascular lesion.Finally introduce the micro-catheter to the internal clot. Dissolve10-200,000U urokinase to 50ml 0.9% normal sodium each time, injectto the obliterate domain within 20-30min;comminute the thrombusautomatically meanwile. Take the super-choose arterio-interventionalthrombolysis therapy, as the therapeutic group.Results: Comparison of neurofunctional impairment scorebetween arterio-intervention group and veno-thrombolysis group:There are significant differences after the arterio-interventional therapyfrom the pretherapy of the intervention. Neurofunctional impairmentscore decrease obviously, P<0.01. There are also distinguisheddifferences after the veno-thrombolysis therapy from the pretherapy ofthe thrombolysis. Neurofunctional impairment score decreaseobviously, P<0.05. A conspicuous contrast exists betweenarterio-intervention group and veno-thrombolysis group.Neurofunctional impairment score decrease significantly, P<0.05.Comparison of adverse reaction between the two groups:all data useline* tabular test. Non-intracranial hemorrhage includes punctio locum,gingival bleeding, UGIH, cutaneous mucosa. Summation of thepatients who undergo the intracranial hemorrhage, non-intracranialhemorrhage and the neurofunctional impairment is prominently lessthan the sum of the veno-thrombolysis group, significant deviationP<0.01. ICH rate of the arterio-intervention group is 1.5%, and ICHrate of the veno-thrombolysis group is 7.7%. There is significantdeviation between the two groups. 5 patients represented thehypertensive disease after the thrombolysis. In addition, 4 patientsundergo the bleeding at the the puncted area. This may be correlatedwith the dys-vasoconstriction and the mal-pressure dressing. Bleedingstopped after the pressure dressing again. ICH and non-ICH afterthrombolysis appeared within 24 hous. ICH within 24h occupies85.7%.23 patients(44%) total revascularization, 19(36%) patientspartial revascularization, 10 patients(19%) nulli-revascularization. Inthe nulli-revascularization patients, ICAO 4 patients;Basilar arteryocclusion 2 patients;middle cerebral artery occlusion 3 patients;vertebral artety bole occlusion 1 patients. The study shows that theocclusive region has notable relation with the revascularization rate:arteria cerebri media revascularization rate is 88%, vertebra arteriabasilaris 75%, ACA 100%;CICA 20%.Conclusion: 1. Arterio-or veno-thrombolysis after 6h iseffective. Significant deviation exists between pretreatment andpost-treatment of arterio-intervention therapy. Significant deviationexists between pretreatment and post-treatment of veno-thrombolysisthrepary. 2. Significant deviation of neurofunctional impairmentscore exists between arterio-intervention therapy and veno-thrombolysis threpary. Arterio-intervention therapy is more effective.3. Summation of the patients who undergo the intracranial hemorrhage,non-intracranial hemorrhage and the neurofunctional impairment inthe arterio-intervention is prominently less than the sum of the veno-thrombolysis group. Deviation of statistics exists. 4. Adversereaction of ICH and non-ICH after thrombolysis appear within 24h.5. The occlusive region has notable relation with the revascularizationrate. Revascularization rate of CICA is the lowest.At present, some overseas literature reported theAtV-union-thrombolysis. Because the brain angiography andmicro-catheter allocation of the Arterio-thrombolysis can prolong thethrombocalstic time., 35 patients in Emergence Management of StrokeBtidging Trial were given 0.6mg/kgtPA through vein within 3h fromonset. tPA20mg is used for interventional therapy if norevacularization appears. 70%patients have residue thrombus.Union-thrombolysis has high revascularization rate, and has the samebleeding rate as the single intervetional-thrombolysis--11.8%.Though the comparison between arterio-interventionalthrombolysis and veno-thrombolysis, we get the conclusion thatarterio-interventional thrombolysis is more effective and has lessadverse reaction. As the development of neuro-interventional materialand techniques, super-choose interventional thrombolysis therapy issecure and effective for acute brain infarction.