The Study Of Intervention Decision-making And Prognosis Of The DSA Negative Ischemic Stroke Patient Within A Thrombolytic Time Window

Objective:To discuss interventional decision-making and prognosis of the DSA negative ischemic stroke patient within the thrombolytic time window (6 hours)。Methods:Collecting our hospital from May 2006 to December 2010, a total of 162 DSA of ischemic stroke patient within the thrombolytic time window (6 hours), including DSA negative (meaning no significant cerebral artery stenosis, occlusion, and blood dynamics normal) 34 patients (20.98%). We determine the criminal responsibility, according to the clinical manifestations, and infuse thrombolytic drugs in proximal area of the criminal endovascular, evaluate state of patients after operation, the use of NIHSS (NIH Stroke Scale) score, and analysis the results. Results:①In all 162 DSA of ischemic stroke patient within the thrombolytic time window (6 hours), there are 34 patients (20.98%) which DSA is negative.②By a comprehensive and detailed examination of a neurologist, make a correct clinical diagnosis and treat with thrombolytic drug in blood vessels of the responsibility, there are 21 patients (61.76%) whose symptom showed complete normal or significant clinical improvement (△NIHSS<-4 points) 21 (61.76%) within 24 hours after reperfusion therapy, but there are 4 patients who are re-aggravated and 3 patients whose infarct of the emergency review head CT was obvious, it is the blood vessel occlusion, the rate was 14.29%,1 patient's head CT is normal, considering the reperfusion injury, The incidence was 4.76%, there are 3 patients whose symptom is significant improvement within a week, the total efficiency of 70.58%; no improvement patients are 10 (29.41%).1 case whose clinical symptom has been completely normal has happen to cerebral hemorrhage after 2 hours of thrombolysis, who was died in the end, the rate was 2.94%. ③In all of improvement patient, there are 9 case we can find a responsibility focal lesions with neurological deficits, accounting for 37.5% of all improvement patient. There are 10 patients (29.41%) whose clinical symptom are improvement,after the first 24 hours, the area of embranchment branches artery shows low density areas in the CTConclusion:①In ischemic stroke patient within the thrombolytic time window (6 hours), DSA negative (meaning no significant cerebral artery stenosis, occlusion, and blood dynamics normal) is the ever-present, it is main due of embranchment arteries or cortical arteries occlusion。②We determine the criminal responsibility, according to the clinical manifestations, and infuse thrombolytic drugs in criminal proximal endovascular, we can obtain better results (70.58% total efficiency), but the risk of cerebral hemorrhage was 2.94% in this group, it can be seen that benefits is far outweigh the risks of thrombolytic therapy in the DSA negative ischemic stroke patient within the thrombolytic time window.③There are some DSA negative patients whose clinical manifestations is not any change after thrombolytic therapy (nearly 29.41%),Now there is no better treatment...