The Clinical Research Of Multi-modality MRI-based Intravenous Thrombolysis With Rt-PA In Acute Cerebral Infarction

Stroke is the third most common cause of death in the china, after cancer and myocardial infarction, and the most common reason for permanent disability. In the USA and Europe, intravenous rt-PA is the only recommended treatment for the acute cerebral infarctions. However, the beneficial therapy was restricted by the increased risk of hemorrhagic transformation (HT) and short time window. In contrast to CT, diffusion-weighted MRI (DWI) can demonstrate ischemic changes within minutes of the onset. Perfusion-weighted MRI (PWI) defines areas of hypoperfusion. The combined data from these 2 modalities can delineate the pathophysiological state of ischemia and may provide a practical means to rapidly and precisely identify the ischemic penumbra in the acute stroke setting. A PWI-DWI mismatch, which indicates tissue with decreased perfusion extending beyond that of diffusion abnormalities, is thought to represent tissue at risk of infarction yet potentially salvageable, e.g. IP. MR angiography (MRA) can localize the vascular lesion.This article will evaluate the application value of multi-modality MRI on intravenous thrombolysis with recombinant tissue plasminogen activator in acute cerebral infarction and the safety and effect of intravenous thrombolysis with rt-PA in acute cerebral infarction.Part 1 the application research of emergency recognization and multi-modality magnetic resonance imaging on thrombolysis therapy inacute cerebral infarctionObjective To evaluate the application value of emergency recognization and multi-modality magnetic resonance imaging (MRI) on intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute cerebral infarction.Methods Total 125 patients with acute cerebral infarction were enrolled. 44 patients that were found compute tomography (CT) scan normal and met the NINDS test thrombolysis criterion, were scanned by multi-modality MRI to assess risks and potential benefits.Results of 44 patients, 17 patients were not meet the multi-modality MRIthrombolysis criterion.2 patients had improving neurological signs and 10 patientsrejected thrombolysis therapy, 15 patients accepted rt-PA therapy.Conclusion multi-modality MRI is helpful to choose those patients that may bebenefit from thrombolysis therapy and exclude those patients who are at the risk ofbleeding after thrombolysis. rt-PA use time window could be expanded bymulti-modality MRI as to those patients between 3 and 4.5 hours from stroke onset.Part 2 the Clinic research of multi-modality MRI-based intravenousthrombolysis with rt-PA in acute strokeObjective To evaluate the efficiency and safety of intravenous thrombolysis withrt-PA in acute cerebral infarction.Methods Total 37 patients with acute cerebral infarction were enrolled, which metthe thrombolysis criterion.20 patients that signed informed consent wereadministrated with rt-PA (0.6～0.9mg/Kg). 17 patients that rejected thrombolysistherapy accepted general therapy. The assessment of nerve function by NationalInstitutes of Health Stroke Scale (NIHSS) score was given before treatment, in 24hours, and on 14th day, 90th day after treatment. A contrast of the Barthel Index (BI)was made before treatment and on 14th day, 90th day after treatment. ModifiedRankin's Score (mRS) at 90th day was also assessed. Meantime, the adverse eventand complication were monitored.Results There were significant difference in NIHSS and BI scale. There were nothemorrhage and dead cases.Conclusion Intravenous thrombolysis with rt-PA within 4.5 hours after symptomonset for acute cerebral infarction is safe and effective.