급성 허혈성 뇌졸중에서 동맥내 Urokinase 및 기계적 혈전용해술과 병용 투여한 동맥내 Tirofiban 치료: 예비 결과
Intra-Arterial Tirofiban Combined with Intra-Arterial Urokinase and Mechanical Thrombolysis for Treatment of Acute Ischemic Stroke: A Preliminary Result
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Background: We investigated the efficacy and safety of intra-arterial (IA) administration of tirofiban, a platelet GP IIb/IIIa inhibitor, combined with IA urokinase (IA-UK) and mechanical thrombolysis in patients with acute ischemic stroke. Methods: Four patients (age: 62-74 yr; 1 male and 3 female) were included in this study. All patients had moderate to severe neurological deficits (National Institutes of Health Stroke Scale score: 10-20), and major arterial occlusion in the internal carotid artery-territory (internal carotid artery=3, and middle cerebral artery=1) within 3 hours after onset of symptoms. At first, all patients had micro-catheter or guidewire thrombus disruption and delivery of UK into the thrombus. After then, IA tirofiban (0.2 μg/kg/min) was administered subsequently. Stent insertion was performed in one patient for improvement of circulation. Neurological outcome measurement and postoperative brain imaging were performed. Results: Three of four patients showed successful recanalization of the occluded vessels, and one patient failed recanalization after IA tirofiban, IA-UK, and mechanical thrombolysis. Three patients with recanalization showed clinical improvement on day 1, and were discharged after thrombolysis. One patient with failure of recanalization died of fatal intracerebral hemorrhage at 7 days after thrombolysis. Conclusion: IA tirofiban combined with mechanical thrombolysis and IA-UK may have a therapeutic potential for recanalization of occluded vessel in acute ischemic stroke. The safety of IA tirofiban needs to be analyzed in further study. (Korean J Stroke 2007;9:113-119)
Abstract
Background: We investigated the efficacy and safety of intra-arterial (IA) administration of tirofiban, a platelet GP IIb/IIIa inhibitor, combined with IA urokinase (IA-UK) and mechanical thrombolysis in patients with acute ischemic stroke. Methods: Four patients (age: 62-74 yr; 1 male and 3 female) were included in this study. All patients had moderate to severe neurological deficits (National Institutes of Health Stroke Scale score: 10-20), and major arterial occlusion in the internal carotid artery-territory (internal carotid artery=3, and middle cerebral artery=1) within 3 hours after onset of symptoms. At first, all patients had micro-catheter or guidewire thrombus disruption and delivery of UK into the thrombus. After then, IA tirofiban (0.2 μg/kg/min) was administered subsequently. Stent insertion was performed in one patient for improvement of circulation. Neurological outcome measurement and postoperative brain imaging were performed. Results: Three of four patients showed successful recanalization of the occluded vessels, and one patient failed recanalization after IA tirofiban, IA-UK, and mechanical thrombolysis. Three patients with recanalization showed clinical improvement on day 1, and were discharged after thrombolysis. One patient with failure of recanalization died of fatal intracerebral hemorrhage at 7 days after thrombolysis. Conclusion: IA tirofiban combined with mechanical thrombolysis and IA-UK may have a therapeutic potential for recanalization of occluded vessel in acute ischemic stroke. The safety of IA tirofiban needs to be analyzed in further study. (Korean J Stroke 2007;9:113-119)