Study Of Individualized Treatment Under The Guide Of Perfusion MR In The Patients With Infarction Within 9 Hours Of Symptom Onset

[Objective]To observe the effects and safety of intravenous thrombolysis(Ⅳ)and intraarterial thrombolysis(IA)under the guide of perfusion MR in the patients with infarction within 9 hours of symptom onset[Metheds]With the mismatch of MR PWI/DWI more than 20%and according symptom on-set to treatment,the patients with infarction within 9 hours of symptom onset were divided into 4 groups:3h after onset of symptom underwentⅣthrombolysis(n=26),3～6h after onset of symptom randomly underwentⅣthrombolysis(n=26)and IA thrombolysis (n=25),6～9h after onset of symptom underwent IA thrombolysis(n=15). Doses ofⅣr-tPA was 0.9 mg/kg,the maximum was 90mg.IA administed with 2 mg r-tPA at first through vessel at affection artery.Observing the reconalization decided to add doses of r-tPA,the maximum wass less than 50 mg.Before and after treating,their National Institutes of Health Stroke scale were evaluated.The activated partial thromboplastin time(TT),prothrombin time(PT),international normalized ratio(INR) and fibrinogen(Fib)were detected before and after thrombolysis 24 h and 7d.Their modified Rankin scale were evaluated after thrombolysis 90d.The CT scan was rechecked after thrombolysis 24h and 7d.Symptomatic intracerebral hemorrhage (sICH)is that intracerebral hemorrhage lead NIHSS score to increase more than 4.[Results](1)After thrombolysis,NIHSS scales were lower in the 0～3hⅣgroup,3～6hⅣgroup,3～6h IA group at 24h,7d,30d(P＜0.05),lower in the 6～9h IA group at 7d,30d(P＜0.05)and not significantly change at 24h(P＞0.05).NIHSS scales were lower in the 3～6h IA group than those 3～6hⅣgroup at 24h(P＜0.05)and not significantly change at 24h,30d(P＞0.05).(2)PT as well as fibrinogen level decrease were more significant in the 0～3hⅣgroup and 3～6hⅣgroup and were not significant in the 3～6hⅣgroup and 6～9hⅣgroup at 24h,7d.PT as well as fibrinogen level decrease were more significant in the 3～6hⅣgroup than that of in the 3～6h IA group(P＜0.05).(3)The total effective outcome were 15 in the 0～3hⅣgroup,13 in the 3～6hⅣgroup,12 in the 3～6h IA group and 7 in the 6～9hⅣgroup.The total fatalities were 2 in the 0～3hⅣgroup,3 in the 3～6hⅣgroup,2 in the 3～6h IA group and 2 in the 6～9hⅣgroup.(4)There were 3 intracerebral hemorrhage,1 digestive tract hemorrhage,3 skin and mucous membrane hemorrhage in the 0～3hⅣgroup.There were 3 intracerebral hemorrhage,1 symptomatic intracerebral hemorrhage,2 digestive tract hemorrhage,6 skin and mucous membrane hemorrhage in the 3～6hⅣgroup.There were 4 intracerebral hemorrhage,1 digestive tract hemorrhage in the 3～6h IA group.There were 5 intracerebral hemorrhage,1 symptomatic intracerebral hemorrhage,2 digestive tract hemorrhage in the 6～9hⅣgroup.(5)The results of brain angiography shew that complete and partial recanalization rates were 40%and 40%in the 3～6h IA group,46.67%and 26.67%in the 6～9h IA group.The total recanalization rates were 77.5%.[Conclusions]when the Brain MR PWI/DWI mismatch more than 20%,The r-tPA intravenous thrombolysis in patients with infarction both in 0～3h and in 3～6h time window showed significantly effective and safe.The r-tPA intra-arterial thrombolysis in patients with infarction both in 3～6h and in 6～9h time window showed significantly effective and safe.The effective and safe is equivalency betweem intravenous thrombolysis and intra-arterial thrombolysis.