[Clinical study of therapeutic time window of local fibrinolysis for acute middle cerebral artery occlusion].
We evaluated the efficacy of local intra-arterial fibrinolysis (LIF) used in tissue plasminogen activator (t-PA) and its indication for acute middle cerebral artery (MCA) occlusion on angiographic degree of leptomeningeal collateral flow in a series of 26 patients (mean age: 67.2 years old). The occlusion types were classified into three types: (1) M 1 proximal occlusion (N = 8) involved the lenticulostriate arteries (LSA), (2) M 1 distal occlusion (N = 6) without involvement of the LSA to M 2 bifurcation, (3) M 2-3 occlusion (N = 12). In M 1 proximal and distal type, 100% patients had complete or partial recanalization till 5.3 and 6 hours, and 91.7% recanalized in M 2-3 type within 3.96 hours from attack on the average. Small cerebral infarction post LIF showed in 50%, but had no clinical change for the worse in all types. There was 65% in excellent or good prognosis on 2 months after attack. Within the range of 600,000-2,400,000 units of t-PA (mean = 1,107,000 units), small hemorrhagic transformation were developed in 5 cases (19.2%) without influence on its outcome. It means that below 2,400,000 units t-PA for LIF were safety amounts. In patients with poor collateral flow in angiographic findings, good prognosis could be possible in 75% within 4 hours (M = 3.96 hours) recanalization on the average. We conclude that LIF used in t-PA would be efficatious in M 1 proximal occlusion within 4 hours of onset and in patients with poor collateral flow when recanalized within 4 hours after attack.
Yamanome
T
T
Iwate Prefectural Ofunato Hospital, Department of Neurosurgery, Japan.
Yoshida
K
K
Ogawa
A
A
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D010959:Tissue Plasminogen Activator