| 조기 CT 징후를 보인 급성 중대뇌동맥부
뇌경색 환자에서 중재적 시술의 임상적 효과 |
| 정슬기, 박만석, 김인규, 김명규, 조기현, 김세종, 김재규* |
| 전남대학교 의과대학 신경과학교실, 방사선과학교실* |
| The clinical usefulness of interventional thrombolytic therapy in acute middle cerebral artery infarction with early CT signs |
| Xeul-Ki Cheong, Man-Seok Park, In-Gyu Kim, Myeong-Kyu Kim,
Ki-Hyun Cho, Sei-Jong Kim, Jae-Kyu Kim* |
| Department of Neurology, Department of Radiology*,
Chonnam University Hospital |
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| Abstract |
Background and Purpose: If early middle cerebral artery signs (EMCAS) are present, prognoses are known to be poor, even if interventional therapy is performed. The aim of this study is to evaluate the clinical effect of a superselective intra-arterial urokinase infusion in cerebral infarction patients presenting EMCAS.
Methods: We conducted prospective longitudinal clinical trial and observed patients (n-22) with middle cerebral artery infarctions who manifested EMCAS in precontrast brain CT scans between January 1996 and April 1997. The patients were divided into two groups, one group (n-11) underwent superselective intra-arterial urokinase infusion; and the other (n-11) was treated with classic osmotherapy and heparinization. We evaluated the clinical outcome for each patient using the Canadian Neurological Scale (CNS) and the National Institutes of Health Stroke Scale (NIHSS) on admission (pre-treatment state) and on, the 3rd, 7th, and 30th days.
Results: The two patients groups had an even distribution of risk factors, EMCAS, age and the interval from the ictus to the initiation of treatment. The outcome at the 30th day after stroke therapy improved for all patients compared to their status on admission (p<0.01), and there was a significant interaction between the group and the time (p<0.01). This means that the group which underwent superselective intra-arterial urokinase infusion had better clinical outcomes. Hemorrhagic transformation occurred in 5 cases (22.7%), 2 from the superselective intra-arterial urokinase infusion group and 3 from the heparinization group. However, this did not influence the clinical outcome.
Conclusions: Compared to previous reports suggesting the poor prognostic value of EMCAS, even when all patients having these signs, this study showed that the clinical outcomes in the thrombolyic therapy group were better than in the conservatively treated one. Therefore, more aggressive interventional therapies such as superselective intra-arterial urokinase infusion may be considered option
Key words: EMCAS (early middle cerebral artery signs), superselective,
intra-arterial urokinase infusion, CNS (Canadian Neurological Scale), NIHSS (National
Institutes of Health stroke scale) |
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