Clinical Study Of Acute Ischemic Stroke Patients Without Visible Angiographic Occlusion On Digital Subtraction Angiogram By Intra-arterial Thrombolysis

ObjectiveBecause of the serious stenosis of the brain artery or all causes of vascular blockage toblock the cerebral blood flow, the central nervous system function is in the state of the defect.It is called Acute Cerebral Infarction (ACI). But in the clinical work, we found that when afew patients who had acute cerebral infarction checked in the Digital SubtractionArteriography (DSA), the whole brain blood vessels were not found significant stenosis orblocking, this is what we mentioned acute ischemic stroke patients without obvious arterialocclusion on DSA. But their absent symptoms of neural function were really existent. Thepossible reasons causing this kind of situation are as follows. Due to the resolution of DSA islower, several small vessels in the deep parts of the brain could not be able to be distinguished.What’s more, because of intravascular thrombosis, it occur to dissolve itself. During theacute period, saving ischemia penumbra and dissolving thrombosis to connect the vascular arethe keys to cure acute cerebral infarction. They are also the theoretical basis of Intra-ArterialThrombolysis (IAT). These patients were not found obvious arterial occlusion on DSAimaging, so it is in controversy at present whether they possess ischemia penumbra, or canthey timely for IAT. There are a lot of reports and information about acute cerebral infarctionwith IAT, but little on this aspect. This study discusses the effectiveness of IAT in the acuteischemic stroke patients without obvious arterial occlusion on DSA, and to provide moreimportant references for selecting the clinical treatment options and the judgment ofprognosis. MethodsWe review the medical records of266acute ischemic stroke patients by IAT who wereadmitted to the department of neurology in the First Hospital of Jilin University betweenMarch2004and October2011, obtaining50cases without obvious arterial occlusion on DSA.The same numbers of coinstantaneous patients were selected to match approximately with thesimilar condition. These patients are respectively grouped according to whether with obviousarterial occlusion on DSA also IAT or not. We statistics the epidemiology conditions, riskyfactors, the frequent site of occurrence, etc of the patients. National Institutes of Health StrokeScale（NIHSS）scores and modified Rankin Scores（mRS）for prognosis after three monthswere evaluated for the patients. Prognosis was regarded as good if the mRS got less than2.We use the two standards to analyze and compare the difference on neurologic impairmentand a good prognosis of each group.Results(1) Of266ACI patients, there are50cases without obvious arterial occlusion on DSA.(50/266, about18.8%)(2) These50cases are with an average age of55years old, it is a statistically significant(P=0.012), and the ages of the patients concentrate on50to60. The top3risky factors are inorder as high blood pressure, diabetes, and smoking. Blood pressure is a statisticallysignificant statistical result (P=0.006, P=0.009), they are all in severe hypertension.(3) Of50cases, brain MRI scanning after24hours appears infarction is36（36/50, about72%）. And the corona radiata is the most frequent site of occurrence.(4) There is significant statistical significance in neurologic impairment at admission andgood prognosis between the group of with obvious arterial occlusion and the group withoutobvious arterial occlusion (P <0.001). About88%（44/50）of the patients had a favorableclinical outcome after3months.(5) There is also significant statistical significance in good outcome whether IAT or no（tP＜0.05）. Conclusions（1）The effect of acute ischemic stroke patients without visible angiographic occlusion ondigital subtraction angiogram is significant, approximately88.0%of patients with good prognosis.（2）The characteristics of the patients are as follows:the age of50to60, with hypertension,diabetes and other risk factors, artery territory ischemia in brain were mainly more common,Common responsibility lesions of the basal ganglia, corona radiata, pons. The study found thatabout72%of non-responsibility of blood vessels in patients appears the review of head CT/MRIresponsibility lesions after intra-arterial thrombolysis.（3）Approximately2.0%of patients with cerebral hemorrhage complications.（4）In this study, the sample size is small, still need to expand the discussion of sample size.