A Comparison Of Efficacy Of Intra-arterial Thrombolysis And Intravenous Thrombolysis In Acute Cerebral Infarction

ObjectiveTo evaluate the safety and efficacy of urokinase in intravenous thrombolysistreatment and super selective arterial thrombolysis treatment in patients with acuteischemic stroke. Observed the effects of intra-arterial thrombolysis recanalization ofvessels.MethodThe clinical data of patients with acute cerebral infarction (ACI) wereretrospectively analyzed. All of the patients are hospitalized patients in China-JapanUnion Hospital of Jilin University department of neurology from August2006toJanuary2013. Patient’s age, gender, body weight, time window of thrombolytictherapy, blood pressure and related laboratory tests,use dosage of the UK, imagingdata were collected before and after the treatment.42patients was respectively placedin a vein thrombolysis group (22cases) and arterial thrombolysis group (20cases).Seldinger technology is adopted by arterial thrombolysis group, the cerebralangiography via femoral artery puncture. Insert a catheter into the cerebral vascularocclusion proximal,for the injection of urokinase. Diluted urokinase were injectedwith intravenous drip in Intravenous thrombolysis group. Two groups were assisted bythe same conventional treatment. The neural function defect scores were comparedbefore treatment and at2h,24h,7d,14d respectively. Two groups of BI index werecompared at28d after treatment. The clinical effects were observed and compared intwo groups．The safety of the two groups of treatment were evaluated by observingthe intracranial hemorrhage and death.ResultThe NIHSS of two groups at2h,24h,7d,14d after thrombolysis weresignificantly lower than that before treatment (P<0.01). The NIHSS of artery thrombolysis group were significantly lower than that of intravenous thrombolysisgroup at2h after treatment(P<0.01). The NIHSS of artery thrombolysis group werelower than that of intravenous thrombolysis group at24h,7d,14d aftertreatment(P<0.05). The significant efficiency rate of artery thrombolysis group washigher than that of intravenous thrombolysis group at14d after treatment(P<0.01).Total effective rate in two groups were no significant difference. The life basicself-care rate(BI≥60) of artery thrombolysis group at28d after thrombolysis werehigher than intravenous thrombolysis group (P<0.05). The disability rate(BI<60) ofartery thrombolysis group were lower than that of intravenous thrombolysis group at28d after thrombolysis(P<0.05). Arterial thrombolysis group has3cases ofintracranial hemorrhage(15%), merger of puncture hematoma in1case,gastrointestinal bleeding in1case, urinary tract bleeding in1case. Intravenousthrombolysis combined with intracranial hemorrhage in3cases (14%),1patients withgingival bleeding,3cases of upper gastrointestinal bleeding.3patients died (15%) inarterial thrombolysis group,3patients died (14%) in intravenous thrombolysis group.18cases（90%）of responsible vascular occlusion were found in arterial thrombolysisgroup, including13cases of internal carotid artery system (72.2%). There were10cases of recanalization after thrombolysis, which complete recanalization in2cases,8cases of partial recanalization,3cases without recanalization, recanalization rate was76.9%; There were5cases of occlusion of vertebrobasilar artery system (27.8%),2cases of recanalization after thrombolysis vessels, including complete recanalizationand partial recanalization in1cases, the recanalization rate was60%.ConclusionUrokinase intravenous thrombolysis and super selective arterial thrombolysisboth have good clinical efficacy and safety. The treatment effect and significantefficiency of super selective arterial thrombolysis group is better than intravenousthrombolysis group. Intra-arterial thrombolysis treatment can improve the patient’squality of life better than intravenous thrombolysis treatment.