Clinical Research For The Reperfusion Of Acute Anterior Circulation Occlusion By Applying Intra-arterial Thrombolysis And Intra-arterial Multimodal Therapy

Objective: AIS is a kind of acute neurologic function damaged clinical event,which is attributed to partly brain tissue and cells anoxia inducing by acute cerebrovascular circulation disorder.AIS presents the characteristics of acute onset,rapid progress,high disability and mortality rate.The prioritized purpose is re-perfused the target occlusion in order to rescue the remaining brain cells in ischemic penumbra.More and more evidence shows that time is brain.However,due to the 4.5 h time window for intravenous thrombolysis,many patients cannot get the standard care timely.In recent years,many clinical stroke center are exploring the intra-arterial treatment,pharmaceuticals and mechanical recanalization,comparing with intravenous thrombolytic therapy,however,few reports about intra-arterial multimodal method have been reported.In this study,we analyzed the combine of intra-arterial rt-PA thrombolysis and other intra-arterial methods and explore the predictors of prognosis in these patients,with the purpose of investigating the safety and effectiveness of the multimodal therapy,which may have important value in theoretical significance and clinical practice.Methods: Data about 59 anterior circulation stroke patients,received intra-arterial therapies,were reviewed from May 2011 to June 2014.Baseline and clinical features were acquired through CT,MRA,CTA,DSA,and follow-up results were collected in order to evaluate prognostic information.National Institutes of Health Stroke Scale(NIHSS)was used for showing the severity,and the modified Rankin scale(mRS)score 90 days after the stroke was measured to reveal clinical outcome.Then,t test or chi-square test was performed for statistics analysis,and multivariable logistic regression analysis was carried out to reveal prognostic factors.Results: During the period,65 patients received intra-arterial therapies with anterior circulation occlusions identified by MRA,CTA,and DSA.A total of 6 patients were excluded due to missing data in this study.The mean age of the remained patients was 59.8 years old.Thirty four patients accepted intra-arterial multimodal therapy(MMT)with a higher baseline admission NIHSS score compared that with the other 25 patients,treated with intra-arterial thrombolysis(IAT;18.3 ± 4.2 vs.12.6 ± 4.3,P<0.001).The MMT patients had a significantly higher patent flow rate as compared with IAT patients(82.4% vs.56.0%,P=0.027).Besides,MMT patients had a significant longer time till accepting treatment(5.8±1.4 vs.5.3±0.9,P<0.001).However,there is no difference in the rate of favorable prognosis,complication of brain hemorrhage and swelling between these two groups.Univariate analysis of the prognosis factors showed the age,NIHSS score at admission and discharge,time to treat,and recanalization relating to the outcome.In multivariate analysis,the age,time to treat,NIHSS score at discharge are predictor for poor outcomes,while perfect recanalization was associated with favorable outcome only.Conclusion: MMT may enjoy higher patency rate than IAT,which can be used for the patients with a severe admission NIHSS score or delayed in admission time.Perfect vessel recanalization is the only predictor for favorable outcome,and MMT may be good for the favorable outcome.