医学
尿激酶
溶栓
替罗非班
改良兰金量表
脑出血
冲程(发动机)
麻醉
外科
内科学
蛛网膜下腔出血
心肌梗塞
缺血
缺血性中风
工程类
机械工程
经皮冠状动脉介入治疗
作者
Yon Kwon Ihn,Jae Hoon Sung,Bum‐Soo Kim
标识
DOI:10.1177/197140091102400614
摘要
We investigated the efficacy and safety of the combined use of IV tirofiban and IA urokinase and/or mechanical thrombolysis for treating acute stroke patients. Thirteen, consecutive patients treated with IV tirofiban and IA thrombolysis with mechanical and/or local IA urokinase infusion were evaluated retrospectively. The amount of time before the beginning of treatment, urokinase dose, recanalization rates, and symptomatic hemorrhage were analyzed. Clinical outcome measures were assessed on admission, at discharge (National Institute of Health Stroke scale [NIHSS]), and three months after the end of their treatment (modified Rankin Scale scores [mRS]). There were 11 patients with internal carotid or middle cerebral artery occlusion treated within six hours of the onset of symptoms and two patients with basilar artery occlusion treated within 12 hours of their symptom onset. The median NIHSS score on admission was 18. The median amount of time from symptom onset to IV tirofiban infusion was 135 minutes, and the median time from symptom onset to IA therapy was 180 minutes. The median dose of urokinase was 200,000 U. Recanalization (thrombolysis in myocardial infarction grade 2 or 3) was achieved in 11 patients. No procedure-related complications were observed. There was one symptomatic hemorrhage. At discharge, the mean NIHSS score was 6.6 (range, 0-15). Overall, at the time of the three-month follow-up the functional outcome was favorable (modified Rankin Scale score 0-2) in eight out of 13 (62%) patients. Death at 90 days occurred in two of the 13 (15%) patients. Combined IV tirofiban and IA thrombolysis with mechanical clot disruption seems to be a feasible treatment in acute stroke and may be successful in re-establishing vessel patency and result in a good functional outcome in patients with major cerebral arteries occlusions.
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