论文部分内容阅读
Background and Purpose -Intraarterial and intravenous thrombolysis are often ineffective for the treatment of acute ischemic stroke and are associated with a significant risk of intracranial hemorrhage (ICH). Multimodal rescue therapy combining mechanical disruption and platelet GPIIb/IIIa receptor antagonists may i mprove recanalization. Methods -Patients who did not recanalize with thrombolys is were treated with GPIIb/IIIa antagonists, angioplasty, or an embolectomy devi ce. Treatment was individualized based on vascular anatomy, stroke mechanism, pa tient status, and symptom duration. Results -Twelve patients were treated withi n 3.8±2.2 hours. The mean National Institutes of Health Stroke Scale (NIHSS) sc ore was 19.4±4.1. Six patients had carotid terminus occlusion, whereas 5 had mi ddle cerebral artery and 1 had basilar artery occlusion. The average doses of in traarterial tPA and reteplase were 17.1±8.6 mg and 2±0.6 units, respectively. All patients received either an intravenous or intraarterial abciximab bolus (me an 11.8±5.8mg) and heparin (mean 3278±1716U). Eleven were treated with angiopl asty and 4 had mechanical embolectomy or stenting. Complete (8) or partial (3) r ecanalization was achieved in 11 cases. There was only one (8.3%) symptomatic h emorrhage. Patients had a favorable outcome at discharge (mean NIHSS 8.9±8.7) a nd 6 (50%) had an NIHSS ≤4at discharge. Conclusions -Multimodal rescue therap y was effective at recanalizing occluded cerebral vessels that failed thrombolys is without an excess risk of ICH.
Background and Purpose -Intraarterial and intravenous thrombolysis are often ineffective for the treatment of acute ischemic stroke and are associated with a significant risk of intracranial hemorrhage (ICH). Multimodal rescue therapy combining mechanical disruption and platelet GPIIb / IIIa receptor antagonists may i mprove recanalization. Methods-Patients who did not recanalize with thrombolys is were treated with GPIIb / IIIa antagonists, angioplasty, or an embolectomy devi ce. Treatment was individualized based on vascular anatomy, stroke mechanism, pa tient status, and symptom duration. Results -Twelve patients were The mean National Institutes of Health Stroke Scale (NIHSS) sc ore was 19.4 ± 4.1. Six patients had carotid terminus occlusion, while 5 had mi ddle cerebral artery and 1 had basilar artery occlusion. The normal doses of in traarterial tPA and reteplase were 17.1 ± 8.6 mg and 2 ± 0.6 units, respectively. All patients received either an intra Eleven were treated with angiopl asty and 4 had mechanical embolectomy or stenting. Complete (8) or partial (3) r ecanalization was achieved in (me an 11.8 ± 5.8 mg) and heparin (mean 3278 ± 1716 U) Patients had a favorable outcome at discharge (mean NIHSS 8.9 ± 8.7) a nd 6 (50%) had an NIHSS ≤ 4 at discharge. Conclusions-Multimodal rescue therap y was effective at recanalizing occluded cerebral vessels that failed thrombolys is without an excess risk of ICH.