動脈溶栓治療大腦中動脈急性腦梗死英文第1頁/共13頁日本腦卒中發(fā)病率（1988-2000）SexdiseaseMalefamaleStroke530/100,000390/100,000日本醫(yī)學介紹2006年第27卷第10期第2頁/共13頁PerThorvaldsen,Stroke.1995;26:361-367中國腦卒中的死亡率第3頁/共13頁日本腦卒中死亡率（1988-2000）SexdiseaseMalefamaleStroke140/100,000100/100,000日本醫(yī)學介紹2006年第27卷第10期第4頁/共13頁高水平證據治療措施的缺乏阿司匹林Antiplatelettherapywithaspirin160to300mgdaily,givenorally(orperrectuminpatientswhocannotswallow),andstartedwithin48hoursofonsetofpresumedischaemicstrokereducestheriskofearlyrecurrentischaemicstrokewithoutamajorriskofearlyhaemorrhagiccomplicationsandimproveslong-termoutcome.13morepatientswerealiveandindependentattheendoffollow-upforevery1000patientstreated10morepatientsmadeacompleterecoveryforevery1000patientstreated

SandercockP,GubitzG,FoleyP,CounsellC.Antiplatelettherapyforacuteischaemicstroke.CochraneDatabaseofSystematicReviews2003,Issue2.Art.No.:CD000029.DOI:10.1002/14651858.CD000029溶栓治療靜脈溶栓

intravenousrecombinanttissueplasminogenactivator,fromwhichtherearethemostevidenceonthrombolytictherapysofar,suggestthatitmaybeassociatedwithlesshazardandmorebenefit.

WardlawJM,delZoppoG,YamaguchiT,BergeE.Thrombolysisforacuteischaemicstroke.CochraneDatabaseofSystematicReviews2003,Issue3.Art.No.:CD000213.DOI:10.1002/14651858.CD000213動脈溶栓

Intra-arterialthrombolysisisanoptionfortreatmentofselectedpatientswhohavemajorstrokeof<6hours’durationduetoocclusionsoftheMCAandwhoarenototherwisecandidatesforintravenousrtPA(ClassI,LevelofEvidenceB).GuidelinesfortheEarlyManagementofAdultsWithIschemicStroke:AGuidelineFromtheAmericanHeartAssociation/AmericanStrokeAssociation.2007;38;1655-1711.卒中單元

Strokepatientswhoreceiveorganisedinpatientcareinastrokeunitaremorelikelytobealive,independent,andlivingathomeoneyearafterthestroke.（scarceofresources）

StrokeUnitTrialists'Collaboration.Organisedinpatient(strokeunit)careforstroke.CochraneDatabaseofSystematicReviews2001,Issue3.Art.No.:CD000197.DOI:10.1002/14651858.CD000197第5頁/共13頁OurStudy第6頁/共13頁ObjectivesToevaluatetheeffectofintra-arterialthrombolysis(IAT)withurokinaseforacuteischemicstroke(AIS)duetomiddlecerebralarteryocclusion(MCAO).ToevaluatethesafetyofIATwithurokinaseforAISduetoMCAO.第7頁/共13頁PatientsandMethods

patientsduetoMCAOinNanjingNo.1hospitalduringJanuary2003throughMay2006IATandnon-thrombolyticcontrolledpatients’informationwascollectedatthesametimethroughNanjingstrokeregistryAllpatients’outcomeswerefollowedfor6monthsprospectively.statisticalanalysisunivariatestatisticbetweenIATandoutcomewascarriedoutwithSPSS10.0第8頁/共13頁inclusioncriterianewfocalneurologicalsignsintheMCAdistributionallowinginitiationoftreatmentwithin6hoursoftheonsetofsymptoms;aminimumNationalInstitutesofHealthStrokeScale(NIHSS)22scoreof4;3age18through80years.第9頁/共13頁exclusioncriteriaanNIHSSscorelessthan4orgreaterthan30,comaorseizuresatonset;suspectedlacunarstrokeorsubarachnoidhemorrhage;previoushistoryofintracranialhemorrhageatanytime,neoplasm,orsubarachnoidhemorrhage;knownoralanticoagulants,baselineinternationalnormalizedratiogreaterthan1.5,orbaselineplateletcountlessthan100x109/L(100x103/μL);historyofstrokewithintheprevious6weeks,headtraumawithin90days;traumawithinternalinjuriesorsurgerywithin30days;activeorrecenthemorrhagewithin14days;uncontrolledhypertensiondefinedbyabloodpressuregreaterthan180mmHgsystolicorgreaterthanorequalto100mmHgdiastolic;intracranialtumorsexceptsmallmeningioma,hemorrhageofanydegreeorlocation,significantmasseffectwithmidlineshift,andacutehypodenseparenchymallesionoreffacementofcerebralsulciinmorethanonethirdoftheMCAterritory第10頁/共13頁IAT’sprocedureAllpatientsreceiveda2000Ubolusanda500U/hrinfusionofIVheparinatthetimeofangiography.Aninfusionmicrocatheter(<?.0F)withasingleendholewasplacedintotheproximalonethirdoftheMCAthrombususingasteerablemicroguidewire.Ifintrathrombuspositioningoftheinfusioncatheterwasnotpossible,thetipofthecatheterwastobeplacedasclosetotheproximalfaceofthethrombusaspossibleforUKinfusion.Completerecanalizationwasdefinedascomplete(TIMI3)flowinboththeM1segmentandM2divisionsoftheMCA.Partialrecanalizationwasdefinedaspartial(TIMI2)flowineitherMCAsegment.第11頁/共13頁AftertheIATComputedtomographicscanswereobtainedatbaseline,24hours,and10daysafterinitialtreatment.Antithromboticagentswereprohibitedforthefirst24hours.Hemorrhagicinfarctionwasdefinedasanyareao