Comparison of intraarterial thrombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator for treatment of ischemic stroke

Objective To evaluate the efficacy and safety of selective intra-arterial thrombolysis in patients with acute cerebral infarction.Methods Forty-three patients with acute cerebral infarction within 6 hours from the onset of symptoms were retrospectively selected.They were divided into an intra-arterial thrombolysis group(n=31)and an intravenous thrombolysis group(n=12).The patients in the intra-arterial thrombolysis group were confirmed as intracranial vascular occlusion with digital subtraction angiography (DSA)and were treated with super-selective arterial thrombolysis(750 000 U);the patients in the intravenous thrombolysis group received intravenous recombinant tissue plasminogen activator(rt-PA) (0.9mg/kg).The recanalization was observed in the intra-arterial thrombolysis group.The NIHSS score and Barthel Index(BI)were followed up in both groups at days 14,90,and 6 months after treatment. Results ①The clinical symptom of 21 patients(67.74%)recovered completely or improved significantly after intra-arterial thrombolysis.The NIHSS score 12±7 at 14 days after the procedure was lower than 15± 4 before the procedure.The difference was statistically significant(P0.01).②After intra-arterial thrombolysis,18 patients achieved complete recanalization,7 achieved partial recanalization,and 6 did not achieved recanalization.The efficacy comparison at day 90 after intra-arterial thrombolysis,the condition of patients in the complete recanalization group was superior to the non-recanalization group.The difference was statistically significant.③The patients with different OCSP classifications after intra-arterial thrombolysis, the NIHSS scores at day14 after procedure were lower than those before thrombolysis.The NIHSS scores at day 90 after procedure were lower than those at 14 days before and after thrombolysis.The difference was statistically significant(P0.05).④There were no significant differences in the incidence of intracerebral hemorrhage after thrombolysis and the NIHSS scores at day 14 and 90 after thrombolysis between the intra-arterial thrombolysis group and the intravenous thrombolysis group(P0.05). Conclusion Intra-arterial thrombolysis within the time window may significantly increase the recanalization rate of the occluded vessels,and improve the clinical condition and long-term prognosis of the patients. The short-term efficacy and long-term prognosis in the intra-arterial thrombolysis group are almost the same with the intravenous thrombolysis group.