Research Of Hyperacute Ischemic Stroke Thrombolytic Therapy Directed By Multi-mode MRI

Objectives: Based on the no matching phenomenon between DWI/FLAIR in multiple patterns MRI.To screen patients in super acute period from brain infarction patients whose onset in 4.5 h- 9 h. through intravenous thrombolysis treatment by r-t PA, and then observe its efficacy and safety. To investigate the guidance function of multi-mode magnetic resonance imaging in the intravenous thrombolysis treatment.Methods:120 patients with acute ischemic stroke of our hospital from January 2012 to December 2014 were included. All of them are 18-80 years of age, the onset of 4.5 h- 9 h,(With the exception of cerebral hemorrhage, brain tumors and obvious low density infarcts by CT, and NIHSS score<25), no contraindications of thrombolysis therapy:(1) have clear head trauma or stroke within the past 3 months;(2) has not pressing parts of artery puncture in the last 7 days;(3) subarachnoid hemorrhage;(4) the recent surgery in intracranial and spinal cord;(5) intracranial tumors, arteriovenous malformation, aneurysm;(6) a history of intracranial hemorrhage;(7) active hemorrhage;(8) hypertension(systolic blood pressure > 185 mm Hg or diastolic blood pressure > 110 mm Hg);(9) acute hemorrhagic diathesis, including but not limited to the platelet count < 100 x 109 / L; heparin therapy In recent 48 hours, APTT was higher than the upper limit of normal range; oral anticoagulants, INR > 1.5 or PT > 15 seconds; The using inhibitor of direct thrombin or inhibitor of direct factor Ⅹ, the ries of sensitive laboratory index;(10) glucose concentration < 2.7 mmol/L;(11) multiple cerebral lobe infarction(low density range of CT > 1/3 hemisphere);(12) serious insufficiency of heart, liver, lung, and renal.MR fast imaging sequences includes: T1WI、T2WI、DWI、FLAIR were finished in 10 min; To screening 45 patients(37.5%) with acute cerebral infarction(DWI slightly high signal, and FLAIR not seen obviously high signal), 75 patients(62.5%) were ruled out. Among the 45 cases, 21 cases who disagree with thrombolysis as control group, the others as thrombolysis group. Each group has four time points:before the treatment;24h after treatment;14d after treatment;90d after treatment. Thrombolysis group was given r-t PA intravenous thrombolysis therapy(0. 9 mg/kg, the maximum dose is 90 mg, 10% of the total dose intravenous within 1 min, the remaining 90% continuous intravenous pumping within 1h), immediately head CT after thrombolysis, antiplatelet aggregation and neural protectants 24 h later. Same treatment without thrombolysis were given in control group immediately.The assessment of resultsis is applicated by NIHSS and Barthel index(BI); To assess the curative effect after treatment by BI index and modified Rankin(m RS) score.All the quantization was performed within SPSS17.0 statistical software package. Measurement data ±s, t-test was used in comparison between groups; The positive rate by percentage, rate compared by χ2 test, P < 0.05 was considered have a significant difference.Results:1 Results of multi-mode magnetic resonance imaging(MRI): there are 45 patients(37.5%) with acute cerebral infarction(DWI slightly high signal, and FLAIR not seen obviously high signal) in 120 cases of onset time within 4.5 h- 9 h, With the exception of cerebral hemorrhage, brain tumors and obvious low density infarcts by CT。2 NIHSS score comparison: there was no statistically significant difference(P > 0.05) between two groups before thrombolysis. Between the other time points, NIHSS score significantly lower≥4 score than control group, the difference was statistically significant(P < 0.05).3 The score of life ability: on all time points, BI score of thrombolysis group were higher than control group, the difference was statistically significant(P < 0.05).4 Patients prognosis: Follow-up patients prognosis on 90 d, BI score and m RS score of thrombolysis group are all higher than the control group, the difference was statistically significant(P < 0.05).5 Adverse events: In thrombolysis group, 24 patients were no massive hemorrhage, asymptomatic cerebral hemorrhage 3 cases, 4 cases with disease progression. In control group, asymptomatic cerebral hemorrhage 2 case, 7 cases with disease progression. The incidence of adverse events was no statistically significant difference(P > 0.05).Conclusions:The r-t PA intravenous thrombolytic therapy were guided by multi-mode MRI define super acute cerebral infarction(DWI slightly high signal, and FLAIR not seen obviously high signal) is a safe and effective method, Multi-mode MRI can define disease onset > 4.5 h or not clear time window of super acute period of cerebral infarction, provide more opportunities for intravenous thrombolysis for patients, to improve the prognosis of patients.