Clinical Efficacy Of The Treatment Of Mechanical Thrombectomy Combined With Rt-PA Arterial Thrombolysis For Acute Cerebral Infarction

Objective:Comparison of mechanical thrombectomy combined with rt-PA artery thrombolytic therapy group and simple rt-PA clinical efficacy and safety of thrombolysis group.Methods:A retrospective analysis from January2011to January2014in Tianjin, People’s Hospital of Neurology seaside hospital treatment in line with intra-arterial thrombolysis and accepted indications arterial thrombolytic therapy in patients with acute cerebral infarction69cases, of which combine mechanical thrombectomy rt-PA arterial thrombolysis group (treatment group) and35cases of34cases of arterial thrombolysis rt-PA group (control group).The treatment group received mechanical thrombectomy combined administration of rt-PA-arterial thrombolysis; control group was given rt-PA alone arterial thrombolysis.Treatment group were compared with the control group baseline clinical data recanalization rate and postoperative (24h,7d,14d,90d) NIHSS score,90d mRS score,90d Barthel index, clinical therapy groups of patients; compare two patients intraoperative rt-PA dosage, postoperative complications and plasma vWF levels, PLT and coagulation, analyze two groups of patients safety.Results:1、Mechanical thrombectomy combined with rt-PA arterial thrombolysis group after (24h,7d,14d,90d)NIHSS score (respectively7.60±5.42,6.143±5.30,5.15±3.03,4.50±2.15) were significantly lower than rt-PA arterial thrombolysis group (11.47±6.03,9.18±5.18,7.39±3.20,4.30±2.44), all P<0.05.90d mRS better than the control group, P<0.05.90d Barthel better than the control group, P<0.05.2、Mechanical thrombectomy combined with rt-PA group arterial thrombolysis recanalization rate was significantly higher than the well-arterial thrombolysis rt-PA group, P<0.05. 3、Mechanical thrombectomy combined with rt-PA arterial thrombolysis group of35patients with cerebral hemorrhage after thrombolysis one case a large number of deaths, asymptomatic cerebral hemorrhage three cases, one case of a large number of the control group died of cerebral hemorrhage after thrombolysis, one case of recanalization progress aggravate adverse cerebral death, two cases of asymptomatic cerebral hemorrhage. Two deaths (x2=0.380, P=0.538) and hemorrhagic transformation was no significant difference in the incidence.4、Mechanical thrombectomy combined with rt-PA arterial thrombolysis amount of rt-PA group (9.14±5.49) mg rt-PA is less than arterial thrombolysis group (13.68±6.43) mg, P<0.05. PLT and coagulation no statistically significant difference between the two groups, suggesting that mechanical thrombectomy combined with rt-PA-arterial thrombolysis little impact on platelet and coagulation functions, security is relatively high.5、Mechanical thrombectomy combined with rt-PA arterial thrombolysis group after24h,7d intimal injury markers vWF (respectively2.48±0.47,1.91±0.39) IU/mL greater than rt-PA-arterial thrombolysis group (respectively2.05±0.42,1.62±0.47) IU/mL,P<0.05.Conclusions:1、Compared with arterial thrombolysis rt-PA group, the mechanical thrombectomy combined with rt-PA arterial thrombolysis patients had significantly better short and long term effects.2、Mechanical thrombectomy combined with rt-PA thrombolytic treatment of acute cerebral artery recanalization rate in the rt-PA alone arterial thrombolysis.3、Mechanical thrombectomy combined with rt-PA group arterial thrombolysis with rt-PA alone arterial thrombolysis group did not increase bleeding and other adverse events.4、Mechanical thrombectomy combined with rt-PA arterial rt-PA thrombolytic therapy group was significantly less than the amount of rt-PA alone arterial thrombolysis, and has little effect on the patient’s platelets and coagulation.5、Compared with arterial thrombolysis rt-PA group, the mechanical thrombectomy combined with rt-PA arterial thrombolysis patients had significantly Severe intimal injury, but long-term efficacy is still better than the simple rt-PA-arterial thrombolysis. Thus, mechanical thrombectomy combined with rt-PA arterial thrombolysis is a safe and reliable technique.