以動脈注射血栓溶劑治療急性缺血性腦中風：七例報告

Intra－arterial Thrombolysis in Acute Ischemic Stroke: Report of Seven Cases

對於急性缺血性腦中風的治療，由於血栓溶劑的使用而有了新的方式，但以動脈注射血栓溶劑療法目前乃屬研究階段，本文華祭七位發病六小時內抵院的急性缺血性腦中風病患為對象，給予動脈注射尿激素治療，七位病人頭部電腦斷層攝影(Computed tomography，CT)均無出血跡象。臨床上的進步是以發病前和發病一星期後的加拿大神經學指標(Canadian Neurologic Scale, CNS)與發病三個月後的Barthel index為評估標準。治療結果顯示七位病人中有五位在後來的血管攝影上可以發現部份或是完全的血管再開通，其餘兩位則無法打通血管。臨床上這五位有再開通的病人，於發病一星期後的CNS均有進步，其中四位於三個月後的Barthel index是介於95到100之間，另兩位血管無法再開通的病人，則分別於接受治療後的第一天和第三天死亡。七位病人中只有一位在治療三天後追蹤的頭部CT有出血現象。我們的結果和國外文獻報告相似，顯示以動脈注射血栓溶劑療法對於某些急性缺血性腦中風的病人是另一種治療選擇。

The management of acute ischemic stroke has been evolving since promising results of thrombolytic therapy for acute ischemic stroke were reported by the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group in 1995. However, the role of intra-arterial thrombolysis in treatment of acute ischemic stroke is still under investigation. We report our experience with intra-arterial thrombolysisi for treatment of ischemic stroke in seven patients. All were brought to our hospital within 6 hours of symptom onset and non had evidence of cerebral hemorrhage on their initial computed tomography scans. Intra-arterial urokinase was applied in the occluded vessel via an angiographic catheter within 8 hours of symptom onset. The clinical response was assessed with paired measurements of the Canadian Neurologic Scale before and 1 week after treatment and the Barthel index at 3 months after onset was also recorded. Five of the seven patients showed partial or complete recanalization with concomitant clinical improvement. Barthel indexes were around 95 to 100 in four patients. The two patients who did not achieve recanalization after treatment died of brain stem failure and increased intracranial pressure, respectively. Follow up computed tomography revealed hemorrhagic transformation in only one patient. Our results are similar to those of previous studies and suggest that intraarterial thrombolysis may be an effective and efficient tool for treatment of selected patients with acute ischemic stroke.