— T * P C H i NGHlfeN CLPU Y HQC
ANH HydNG CUA BifeU TR! TIEU HUYET KHdl ALTEPLASE DydNG TINH MACH DEN CAC K^T QUA MACH MAU VA LAM SANG d BENH NHAN TAC DONG MACH NAO GldA
Mai Duy T d n \ Dinh Manh Phu'O'ng^, Nguyen Dat Anh^
'S0n/7 viin Bach Mai, 'Binh viin Tuyin Quang Nghien ciru thuc hien tren 62 binh nhan nhoi mau nao do tac dpng mach nao giO'a duvc diiu tq thuoc lieu huyet khoi alteplase duong tinh mach tmng cua sd 270 phut tai Khoa Cip cuv - binh viin Bach Mai tir thing 12/2009 den thing 7/2013 nham dinh gii hiiu qui vi hinh anh mach miu nao vi mdi liin quan din mCfc do hdi phuc lam sang sau 3 thing va biin chimg chiy miu ngi SQ sau 24 gid. Mirc dd tii thdng mach nao dat ty li 61,3%, nhom tai thdng mach, muc dg hdi phuc lim sang sau 3 thing cao gip 21 lin so vdi nhdm khdng cd tii thdng mach (p < 0,001). Chay mau ndi SQ sau 24 gia d nhdm cd tii thdng mach cao han nhdm khdng cd tii thdng mach (p < 0,05) Chay miu npi SQ co trieu chung chi 1.61%. Muc dQ hdi phuc iam sang tot sau 3 thing dat ty li 43.5%. Kit qua nay cho thay dieu tri thudc tiiu huyit khoi alteplase du&ng tinh mach a binh nhan nhoi mau nao do tic dpng mach nio giira tmng vdng 4,5 gia an toin vi cd hiiu qua.
TCr khoa: dong m^ch nao gida, tiSu huylt khdi, tai thdng m^ch nao
I. DAT
V A NBt
N h l i mau nao do t i c dpng maeh ngo gida la mdt benh cd tien l y g n g t d vong va tan p h i rat cao. Theo mot nghien cdu, trong hai nam 2007 - 2008, tai khoa T h i n kmh Bgnh vien I Bach Mai, nhyng bgnh nhan n h i l mgu nao do t i c ddng mgch ngo gida d y g c dieu tri ndi khoa thydng quy thi ty le t d vong lg 15,2%, tan phe la 76,8% [1]. Hien nay, d n h i l u co s d y te, d i l u tn bgnh nhgn n h i i mgu ngo do t i c ddng mach nao gida chu y l u la dieu tri not khoa, benh nhan h l u h i t khdng d y g c tiep can vdi cac phyong phgp dieu tn tieh cgc nhy can thigp ndi mgch lay huyet k h l i , d i l u tn t h u l c tidu h u y l t k h l i d y d n g tTnh mach. Do vgy, ty lg t d vong cung nhy b i l n chdng c h i c c h i n se r i t khd d y g c cai thign B e lgm giam ty lg t d
0/a chllien h$- Mai Duy T6n, Khoa Cap cim, b$nh vi$n Bach Mai
Email- tonresiclenl@gmail com Ngiy nhan: 16/01/2015 Ngiy duoc chap thu$n: 18/5/2015
vong vg di chdng, d i l u tn t h u i c tigu h u y l t k h l i dydng tTnh maeh trong thdi gian 270 phut ke t d khi benh nhgn xuat hien trigu ehdng khdi phgt d i u tign lg mdt bign phgp quan trong nhat. Dgnh gia k i t qua d i l u tn cOng nhy cgc bien chdng cd the xay ra phu thupc nhieu yeu t l nhy thdi gian ke t d khi benh nhan khdi phat den liic dung t h u l c , tuoi cua bgnh nhan, tang h u y l t ap, dgi thgo d y d n g , mdc dO t i n thyong trgn hinh anh so nao, va dae bigt lg k i t qua d i l u tri t h y d n g lidn quan d i n mdc dp tai thdng mach ngo sau khi diing t h u l c tigu huyet k h i i [2, 3]. Mot s l nghign c d u da chdng mmh cd m l i lien quan ehat che gida mdc dd tgi thdng mgch ngo sau 24 gid diing t h u i c tieu h u y l t k h i i alteplase d y d n g tTnh mach vdi k i t qua h i i phuc lgm sgng sau 3 thang [2 ;4, 5; 6]. Chinh vi vgy chung tdi t i l n hanh nghign c d u ngy n h i m myc tieu- Dgnh gig higu qua ve mat hinh anh mach nao cua d i l u tri t h u i c tigu h u y l t k h i i alteplase d y d n g tTnh maeh a bgnh nhan n h l i mgu ngo do t i c ddng mgch nao gida.
TCNCYH 93 (1) - 2015
TAP CHi NGHIEN ClJU Y HQC •
11. DOI TU'O'NG VA PHUONG PHAP
1. Ddi tygng
Benh nhgn nhoi mgu ngo e l p nhgp vien khoa cap cdu trong thdi gian t d thang 12/2009 d i n thang 7/2013 dgp dng du eac tieu chuan lya chpn va loai trd :
1.1. Tieu chuin lira chgn
- T u i i bgnh nhan > 18 tuoi; khdi phgt dot quy rd rang < 4,5 gid t r y d c khi dung alteplase;
- Cd t i c ddng mach nao gida tren chyp c l t ldp vi tinh va cdng hydng t d mach nao;
- Gia dinh benh nhgn va/hoac benh nhgn d i n g y diing thuie
1.2. Tieu chuan loai trie (khi cd mdt trong cae tigu chuan sau)
- Cgc benh nhgn dot quy nao khdng do t i c dpng mach ngo gida.
- O l i vdi cgc bgnh nhgn cd thdi gian khdi phat dot quy nao sau ba gid d i u chiing tdi loai tor dya theo nghien cdu ECASS 111 [3], thgm 4 tieu chuan
+ Cac bgnh nhgn cd t u l i trgn 80.
+ cae benh nhgn dang d i l u tri t h u l c c h i n g ddng dydng u i n g
+ Cgc benh nhan cd diem NIHSS ban d i u trgn 25 diem.
+ Cae bgnh nhan cd t i l n s y ddt quy nao vg dai thao dydng k i t hop.
- Ching chl djnh dung t h u i c alteplase n l u cd m i t trong cae tigu chuan.
+ Cac trieu chdng khdi phat ciia ddt quy nao trgn 270 phiit tinh den thdi diem b i t d i u diing t h u l c alteplase hoac khdng xae dinh chinh xgc thdi gian.
+ Dot quy nao nhe, don thuan hogc cat thien nhanh chdng
+ Khdi phgt cd dau higu co giat.
+ Khdng chup c l t Idp vi tinh sp nao khdng can quang va/hoac chyp edng hydng I d sp ngo hoge cd chay mau ngo trgn chup c l t ldp
VI tinh so nao vg/hoac chup cdng h y d n g ti>
sp nSo
+ Cgc tngu chdng ddt quy ngo ggi y den c h ^ mgu dydi nhgn mgc du ket qua chup c l t Idp vi tinh sp ngo va^ogc cdng h y d n g t d sg nao binh thifdng.
+ Hinh anh chyp c l t Idp vi tinh sp nao vg/
hoge edng hycrng t d sp nao ed nhoi mau ngo trgn 1/3 di0n ehi p h i i ddng mgch nao gida.
+ Khi d i l m NIHSS trgn 24 hogc d y d i 4 + C h i n t h y o n g hogc chay mgu t i l n trien.
+ T i l n s y ddt quy nao, chan thyong diu mdc dd nang, n h i i mau c o tim hogc phlu thugt sp nao trong vdng 3 thgng g i n dgy.
+ T i l n s d ehay mgu nao; tien s d chay mau dydng tieu hda, d y d n g t i l t nieu frong 21 nggy.
* T i l n s d chan t h y o n g Idn hogc phlu thugt Idn trong 14 nggy g i n day.
+ Choc dd dich nao tuy hogc chgc dd dpng mach d nhdng noi khdng the ep d y g c trong vdng 7 ngay g i n day.
+ Bgnh ly trong so (u, di dang ddng - tTnh maeh nao, tui phinh mgch nao).
+ Cd bat t h y d n g v l d y d n g huyet (dydi 2,8 mmo/l hogc tren 22,2 mmol/l).
+ S i l y g n g tieu c l u d y d i 100,000/mm^
+ H u y l t ap khdng kiem sogt d y g c (huy^
ap lam thu trdn 185 mmHg hogc h u y l t ap tgm tryong tren 110 mmHg).
+ Dieu tri t h u i c c h i n g ddng g i n day vdi ty le INR trgn 1,5 i l n chdng.
2. Phu'ong phap
Thiet ke nghien CLFU Nghign cdu tien c y u , so sgnh t r y d c vg sau dieu tn.
Phuvng phAp: B6nh nhgn nhoi mgu nSo do t i e ddng mach ngo gida e l p dap dng du eae tigu c h u i n lya chpn va khdng ed cac tiSu chuan c h i n g chi dinh se d y g c dCing thuic Actilyse (alteplase) lieu 0,6mg/kg Tiem bolus 15% t i n g lieu trong 1 phiit, 85% lu'ong thuic cdn lai d y g c t r u y i n ITnh mach lign tuc trong 60
40 TCNCYH93(
• TAP CHl NGHIEN Cl>U Y HQC phut. Sau 24 gid bgnh nhgn d y g c chyp hinh
anh sp va mgch nao d l dgnh gig tai t h i n g mgch, phgn loai m d c do tgi thdng maeh nao theo tigu c h u i n MORI gom 4 mde dd [2]
MORI 0- khdng cd tai thdng; MORI 1: tai thdng mach mau r i t it, MORI 2: tai thdng mgch mgu mpt p h l n ; MORI 3: tdi thdng mgch mau hogn togn va bien chdng chay mau npi sg d y g c phan thanh b i n mdc d l theo tigu chuan ECASS [3] g i m : H l l chay mau nho dgng cham, a vung ria cua i n h l i mgu, HI2:
chay mgu dang eham trong i n h i i mau, khdng ggy hieu dng chogn cho, P H . cyc mgu ddng d y d i 3 0 % o n h l i mgu, mdt s i cd gay hieu dng choan chd nhe; PH2: cue mgu d i n g tren 30% 6 n h i i mgu, ed ggy hieu dng chogn
III. K^T QUA
chd dgng k l ( H l l vg H12 d y g c xem lg chay mgu nao khdng ed tri^u ehdng, PHI va PH2 d y o c xem lg ehay mau ngo cd tngu chdng).
Ganh gia thang d i l m tgn p h i rankin higu chinh sau 3 thang. Biem rankin 0 - 1 d y g c xem la hit phyc tot.
3. Xif ly s 6 li§u: S i li§u d y g c thu thap theo m i u bgnh an t h i n g n h i t va x d ly theo phyong phgp t h i n g ke y hpc SPSS 17 0
4, Dao dii-c nghien c d u
Bgnh nhan d y o c giai thieh v l myc dich va phyong phap nghign edu, chl nhdng bgnh nhgn d i n g y t g nguydn tham gia mdi d y g c dya vgo de tai nghign edu Bgnh nhan cd q u y i n t d bo khdng tham gia nghign cdu t i l p trong bat ki thdi diem ngo.
Bang 1. Hieu qua tai t h o n g mach nao sau d i l u trj t h u d c tidu huygt khdi
MORIO M 0 R I 1 MORI 2 MORI 3
D i ^ m MORI n
24 8 12 18
%
38,7 12,9 19,4 29
Sau d i l u tri thudc tieu huyet k h l i : Ty le bgnh nhan e l tai thdng maeh nao lg 61.3%, Trong dd tai t h i n g hoan toan c h i l m 29%. Ty lg bgnh nhan khdng c l tai thdng mach mau lg 38,7%
Bang 2. MIPC d o hoi phuc lam sang sau 3 t h a n g
D i ^ m mRSO m R S 1 mRS 2 mRS 3 mRS 4 mRS 5 mRS 6
Rankin SLpa d d i (mRS) n 11 16 6 11 10 7 2
%
17,7 25,8 8,1 17,7 16,2 11,3 3,2
TCNCYH 93(1)-2015
TAP CHi NGHIEN CCPU Y HQC -
Sau 3 thang, s l bgnh nhan dat k i t qua iam sang t i t (mRS 0 - 1 ) lg 43,5%. C d 2 benh nhgn tu vong, ehilm ty lg 3,2%.
Bang 3. Lien quan giO'a mi>c dd tai thong mach va mu'c d6 hdi phuc lam sang
mRS 0-1 mRS 2-6 J*^"^^"'!'"'oS"?' P
khoang tm cay 95%(CI) n % n %
MORI 1 - 3 (n = 38) 25 65,8 13 34,2 21,1 (4,3 - 104.27) < 0.001 M O R I 0 ( n = 24) 2 8,3 22 91,7
Bgnh nhgn h i i phyc lam sang t i t sau ba thang d nhdm ed tai thdng maeh mau cao g i p 21,1 i l n so vdi nhom khong cd tai thdng.
Bang 4. Cac the chay mau ngi so sau d i l u trj thudc tieu huygt khdi
HI 1 HI 2
Th^ chay mau n
2 8
%
PH 1 1 P H 2
Tong
0
11 17,7
B^nh nhan chay mSu nao co trieu chi>ng chi^m ty le 1,61%. Benh nhan chay mau nSo khflng CO trieu chi>ng chiem ty le 16,09%.
Bang 5. Lien quan giu'a mirc do tai thong mach v 6 i chay mau trong so
Co chay mau Khong chay mau , J * ^ " ! " = ' ' f " ^ i S ? ' p
" ' lihoang tin cay 95%(CI) "^
n % n %
MORI 1 - 3 (n = 38) 10 26,3 28 73,7 8 , 2 ( 0 . 9 9 * 6 9 , 0 0 ) F*:0,039 MORI 0 (n = 24) 1 4,2 23
Bien chtrng chay m^u trong sp sau dieu tri thuoc ti&u huyet khfli o nhbm co tai thong mach mau cao gap 8,2 lan so vdi nhom kh6ng c6 tai thflng mach mSu.
TCNCYH 93 {1 ,5
• TAP CHi NGHieN CI>U Y HQC
IV. BAN LUAN
Sau d i l u tn t h u i c tigu huyet k h l i 24 gid, cgc bgnh nhan d y g c chyp cdng h y d n g t d hoae chyp c l t Idp vi tinh mach mau de dgnh gia tinh trgng tai thdng mgch mgu. K i t qua bang 1 cho t h i y , ty lg tai thdng mach mau nSo lg 61,3%, trong dd tgi thdng hogn toan e h i l m 29%; cdn ty le bdnh nhan khdng cd tai thdng mgch ngo lg 38,7% Ket qua trdn g i n tyong t g k i t qua ciJa Mori trgn 58 bgnh nhgn t i c dpng mach nao gida d y g c d i l u tn alteplase lieu thap 0,6 mg/kg, ty Ig tgi thdng mach mgu sau 6 gid dung t h u i c lg 51,7%, sau 24 gid lg 69,0% [2]. Cdn theo N g u y i n Huy T h i n g thi ty le tgi thdng mgch sau dieu tn t h u i c tieu huyet k h i i lieu 0,9 mg/kg trdn 64 bgnh nhan nhoi mau nao do t i c ddng mach nao gida la 43,8%, ty le nay t h i p hon so vdi chung tdi [4].
Nghien c d u cua Alexandrov trgn 60 benh nhan t i c dpng mach ngo gida dogn M l va doan M2 d i l u tn t h u l c tidu h u y l t k h i i dydng tTnh mgch vg theo ddi tgi thdng maeh bang sieu gm doppler xuyen so K i t qua cd 30% dat tai t h i n g hoan toan, 4 8 % tgi thdng mdt phan va 22% khdng cd tgi thdng mach [5].
Theo Wunderlich, ty lg tai thdng hoan togn vg m|t p h l n d i i vdi bgnh nhan t i e ddng mgch nao gida sau d i l u tri t h u i e tigu h u y l t k h i i 24
gid la 6 1 % , tac gia cung eho r i n g vige tai thdng mgch mgu ngo sau 24 gid iam cai thign k i t qua tgi thdi d i l m 30 ngay [6]. Nghign cdu cua ehiing tdi eOng thay s g khgc bigt cd y nghTa t h i n g kg v l k i t qua phyc h i i iam sang t i t sau ba thgng gida nhdm bgnh nhgn cd tai t h i n g mgch mgu so vdi nhdm k h i n g ed tai t h i n g O nhdm c l tai thdng, ty lg bgnh nhgn cd mdc d l h i i phyc lgm sang t i t tyong dng vdi diem mRS 0 - 1 lg 65,8%, cao gap 21,1 lan nhdm khdng ed tai t h i n g mgch mgu (p <
0,001) (bang 3).
T i t ca eae bgnh nhgn d i u d y g c theo ddi sau ba thang d l dgnh gig kha nang hoi phuc iam sgng K i t qua d bang 2 cho thay, ty le bgnh nhgn ed k i t qua ISm sgng t i t (cd diem Rankin sda d l i 0 - 1) la 43,5%. Od hai bgnh nhan t y vong, chiem ty le 3,2%, nguydn nhan t y vong cua hai bgnh nhan nay deu khdng lign quan d i n bien chdng eua d i l u tn t h u i c tieu h u y l t k h i i alteplase Ca hai bgnh nhgn deu t i c dpng mach nao gida doan M l , khdng ed tgi thdng mgch mgu, va ed mdc dd tan tat nang (mRS = 5), phai m d khi quan sau dd t d vong trong bgnh eanh vigm phoi bgnh vign vg s i c nhiim k h u l n
Khi so sgnh vdi nghien c d u trong n y d c va q u i c te trinh bgy d y d i :
Bang 6. MiPC d d hdi phuc lam sang sau ba thang giOa cgc nghien c d u
Nghien cii'u Chung toi
Nguyin Huy Thing [4]
Mori [2]
mRS 0 -1 43,5%
18,8%
46,6%
mRS>2 56,5%
81,2%
53,4%
Nhy vay, ty Id h i i phuc t i t sau ba thang vdi diem Rankin sda d i i 0 - 1 d bgnh nhan ddt quy nao do t i e ddng mgch nao gida trong nghign cdu eua ehiing t l i gan tyong t g nhy eiia Mori nhyng eao hon cua Nguygn Huy T h i n g .
TCNCYH 93(1)-2015
TAR CHi NGHIEN cO'U Y HQC -
Trong nghign edu ngy cd 65,8% benh nhgn trong nhdm tgi t h i n g mgch mgu cd k i t qua phue hoi lam sdng t i t (mRS 0 - 1 ) , so vdi chf 8.3% d nhdm khdng cd tai thdng mgch mgu, s g khgc bi^t nay cd y nghTa t h i n g kg (p < 0,001; OR 21,154; 01 4,292 - 104,269) (bang 3). K i t qua ngy tyong t y vdi k i t qua nghign cdu ciia Mori [2], cd ty lg phuc hoi than kinh t i t d nhdm ed tai thdng mgch la 62,5%, d nhdm khdng tai t h i n g lg 11.8% (p < 0,001; OR 12,5; Cl 2,503 - 62,428). Nghign cdu cua Nguygn Huy T h i n g [4], ty le phyc hoi t h i n kinh t i t d nhdm ed tai thdng mach lg 39,3%, cdn d nhdm khdng cd tgi thdng mgch lg 2,8%
(p < 0,001), ty lg ngy thap hon so vdi nghign cdu cua chiing t l i . Bien chdng chay mau ndi sp lg bien chdng dgng nggi n h i t trong d i l u trj tigu h u y l t k h i i , trong nghidn cdu cd 11 bdnh nhan cd bien chdng chay mgu npi so, c h i l m ty ig 17,7%, trong dd chicd 1 bgnh nhan (1,61%) cd b i l n ehdng ehay mgu npi so cd trigu chdng, benh nhgn nay d trong nhdm dieu trj trong vdng 3 gtd dau.
So sanh vdi cac nghidn edu khac v l bien chdng ehay mau npi so ed trieu chdng (theo ECASS III) sau dieu trj t h u i c tigu h u y l t k h i i d bgnh nhgn t i c d i n g mgch ngo gida
Nhy vay, vdi lieu t h i p 0,6 mg/kg b'ong nghign cdu cua ehiing t l i cd 1,61% bgnh nhan cd bien chdng ehay mau ndi so ed tneu chyng. Trai Igi, ty Ig bgnh nhgn t i c ddng mgch ngo gida cd b i l n chdng chay mgu nOi sp c l trigu chdng vdi lieu dieu tri 0,9 mg/kg cua Nguygn Huy T h i n g la 6,3%
Theo Molina tren 32 bgnh nhgn t i e dpng maeh nao gida dogn g i n cho t h i y bgnh nhan sau dieu tn t h u i c tieu h u y l t k h i i ma cd b i l n chdng ehay mgu the HI thi ehinh la d i u higu cua tai'thdng mach sdm, d i n tdi giam the tich i n h i l mgu vg cai thign chdc ngng lgm sang sau ba thang [7].
Khi phgn tich cgc y l u t i lidn quan vdi bien chdng chay mau trong sg chiing tdi thiy, Chung tdi cung t h i y cd s g khac bigt c6 y nghfe t h i n g kg ve ty lg ehay mgu gida nhdm cd ta thdng mach vg nhdm khdng tai t h i n g mach;
Ty lg cd bien chdng chay mgu trong sg o nhdm cd tgi thdng mgch la 26,3%, cao hon d nhdm khdng cd tai thdng mgch chiem ty 1$
4,2% (bang 5).
V. K^T LUAN
Qua nghign cdu 62 benh nhgn t i c dpng maeh nao gida d y g c dieu tri thuoc tidu huylt k h i i d y d n g tTnh mgch trong 270 phut, chiing toi nit ra mpt s i k i t lugn sau:
Mdc dd tgi thdng mach nao dat ty lg 61,3%
va cd m l i lidn quan vdi m d c dp h i i phyc lam sang sau 3 thgng vg chay mau ndi so sau 24 gid.
Mdc dp hoi phyc Igm sgng t i t sau 3 thang dgt ty le 43,5%. Chay mgu ndi sp cd trieu chdng lg 1,61%.
Lo'i c a m o^n
Nghien cdu d y g c hogn thgnh nhd s g hop tac ciia bgnh nhgn dg d i n g y tham gia nghign cdu, d i n g thdi cd s g ddng gdp cua tgp th§
bac sy, y ta khoa C i p c d u va khoa Chan dogn hinh anh bgnh vien Bgch Mai
TAI LIEU THAM KHAO
1. Doan Thj H u y I n , Lg Van Thinh (2009).
Nghien cdu dgc diem lgm sgng, hinh anh hpc t h i n kinh va tign l y g n g ciia nhoi mgu nSo khu vye ddng mach ngo gida. Tap chl Y hoc Binf) vien Bach Mai. 42, 7 - 14.
2. Etsuro Mori, Kazuo Minematsu, Jyoji Nakagawara et al (2010). Effects of 0.6 mg/
kg Intravenous Alteplase on Vascular and Clinical Outcomes in Middle cerebral Artery Occlusion. Stroke. 4 1 , 461 - 4 6 5
TCNCYH 93(1)- 115
• T4P CHl NGHIEN CU'U Y HQC
3. Hacke W, Kaste IVI, Fieschi C et al with intravenous tissue plasminogen activator, (1995). Intravenous thrombolysis v»ith recom- Neurology, 59(6), 862 - 867.
binant tissue plasminogen activator for acute e. Wunderlich IW.T, Goertler M, Poster T, hemispheno strolie. The European Coopera- et al (2007). Recanalization after intravenous tive Acute Strolie Study (ECASS), JAMA. 274, thrombolysis, does a recanalization time 1017-1026. windovKexist?, Newo/ogy, 68, 1364-1368.
4. T. H. Nguyen, A. T. L.Truong, IW. B. 7 carlos A., Molina,, Jose Alvarez - Ngo et al (2010). Patients with Thrombolysed sabin et al (2002). Thrombolysis-Related Stroke in Vietnam have an Excellent Outcome: Hemorrhagic Infarction • A Marker of Early Results from the Vietnam Thrombolysis Regis- Reperfusion, Reduced Infarct Size, and try, European Journal of Neurology, 1 - 9 Improved Outcome in Patients With Proximal
5. Alexandrov A.V, Grotta J.C (2002). Middle Cerebral Artery Occlusion, Stroke, 33, Arterial reocclusion in stroke patients treated 1551 -1556.
Summary
EFFECT OF INTRAVENOUS ALTEPLASE THROMBOLYSIS ON VASCULAR AND CLINICAL OUTCOMES IN MIDDLE CEREBRAL
ARTERY OCCLUSION
The purpose of the study was to evaluate the efficacy of vascular outcomes and the relation to clinical outcomes after 3 months and intracranial hemorrhage complications after 24 hours. The study population was composed of 62 ischemic stroke patients with middle cerebral artery occlu- sion treated with intravenous alteplase thrombolysis within 270 minutes from onset at the Emergency Department - Bachmai hospital from 12/2009 to 7/2013. The rate of cerebral vascular recanalization was 61.3%; After 3 months, good clinical outcome was 21 times higher in group with recanalization when compared with group without recanalization (p < 0 001) The intracranial hemorrhage in recanalization group was higher than group without recanalization after 24 hours (p < 0.05), The rate of symptomatic intracranial hemorrhage was only 1.61%, The good clinical outcome was 43.5%. These results showed that treatment with intravenous alteplase in middle cerebral artery occlusion within 270 minutes was effective and safe.
Key words; middle cerebral artery, thrombolysis, recanalization
TCNCYH 93 {1) - 2015
