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KMID : 1005420070090040265
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Journal of Cerebrovascular and Endovascular Neurosurgery
2007 Volume.9 No. 4 p.265 ~ p.270
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Recanalization Rate and its Associated Factors after Intravenous Tissue Plasminogen Activator Thrombolysis for Acute Major Cerebral Arterial Occlusion
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Yoon Won-Ki
Kim Young-Woo
Kim Sung-Rhim
You Seung-Hoon
Park Ik-Seong
Kim Sang-Don
Baik Min-Woo
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Abstract
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Purpose: To investigate the recanalization rate after intravenous administration of recombinant tissue plasminogen activator (IV-tPA) for acute major arterial occlusion of the anterior cerebral circulation and to investigate the relationship between atrial fibrillation and recanalization.
Methods: From April 2005 to April 2006, 16 patients with acute major arterial occlusion of the anterior cerebral circulation were treated with IV-tPA. Recanalization was classified as good (as compared with an unoccluded contralateral vessel; thrombolysis in myocardial infarction (TIMI) classification grade II and III) and poor (TIMI grade 0 and I). The clinical and radiological parameters associated with recanalization were analyzed. The clinical outcomes were evaluated by use of the National Institute of Health Stroke Scale (NIHSS) at 3 months after treatment.
Results: Of all of the 16 patients, 11 patients (68.8%) showed good recanalization. Among these 11 patients, nine patients survived (81.8%). However, only one patient survived (20%, p = 0.036) of the other five patients who showed poor recanalization. The pretreatment NIHSS score and atrial fibrillation were significantly correlated with the recanalization rate. Atrial fibrillation was found in 8 of 16 patients (50.0%) as the cause of the cerebral embolic infarction. Among the patients with atrial fibrillation only three patients showed good recanalization (37.5%); patients without atrial fibrillation showed good recanalization (100%, p = 0.026).
Conclusions: I.-tPA appears to be effective and safe as a recanalization method for acute major cerebral arterial occlusion in patients that do not have atrial fibrillation. Good recanalization was associated with a good clinical result. Atrial fibrillation is a significant associated factor of poor recanalization and high mortality.
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KEYWORD
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Atrial fibrillation, Cerebral arterial occlusion, Recanalization, Tissue plasminogen activator
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