18-29ÀÌ´öÈñ

Size: px

Start display at page:

Download "18-29ÀÌ´öÈñ"

태근 단
8 years ago
Views:

1 Review Key Words : Stroke; Thrombolysis; Revasculaization treatment; Mechanical thrombolysis Received May 8, 2006; accepted after revision July 15, Correspondence to: Deok Hee Lee, MD, Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poognap-dong, Sonpa-gu, Seoul , Korea Tel Fax dhlee@amc.seoul.kr Neurointervention 2006;1: Neurointervention 1, August 2006

Correspondence to: Deok Hee Lee, MD, Department of Radiology, Research Institute of Radiology, Asan Medical Center,

2 Neurointervention 1, August

3 Fig. 1. Functional outcome represented as mrs and comparison of current domestic results with those of control and treated groups of major thrombolysis trials. Table 1. Univariate Relationships of Significant Hemorrhage after Thrombolysis Variable Odds Ratio P value Demographic Age (>65y) Sex (male) Diabetes Hypertension Cardioembolism Initial NIHSS score CT findings Positive early CT sign Violation of one-third rule Basal ganglia involvement Hyperdense MCA sign (+) MR findings DWI lesion over 1/3 of MCA territory DWI lesion over 1/2 of MCA territory Basal ganglia involvement Presence of diffusion-perfusion mismatch Visible dark clot on T2*-weighted images Procedure and post-procedure imaging findings Within working hours Within 3 hours after symptom onset Within 6 hours after symptom onset Combined IV thrombolysis Combined mechanical thrombolysis Failed recanalization Any contrast staining on post-ct 15.8 < Contrast extravasation on post-ct 14.9 < Table 2. Univariate Relationships with Poor Functional Outcome (mrs > 3) Variable Odds Ratio P value Demographic Age (>65y) Sex (male) Diabetes Hypertension Cardioembolism Initial NIHSS score < CT findings Positive early CT sign Violation of one-third rule Basal ganglia involvement Hyperdense MCA sign (+) MR findings DWI lesion over 1/3 of MCA territory DWI lesion over 1/2 of MCA territory Basal ganglia involvement Presence of diffusion-perfusion mismatch Visible dark clot on T2*-weighted images Procedure and post-procedure imaging findings Within working hours Within 3 hours after symptom onset Within 6 hours after symptom onset Combined IV thrombolysis Combined mechanical thrombolysis Failed recanalization Any contrast staining on post-ct Contrast extravasation on post-ct Significant hemorrhage Neurointervention 1, August 2006

044 Cardioembolism 1.38 0.51 Initial NIHSS score 15 3.75 0.046 CT findings Positive early CT sign 1.80 0.38 Violation of one-third rule 4.42 0.08 Basal ganglia involvement 4.08 0.

4 Neurointervention 1, August

5 22 Neurointervention 1, August 2006

6 Neurointervention 1, August

7 24 Neurointervention 1, August 2006

8 Neurointervention 1, August

9 26 Neurointervention 1, August 2006

10 Neurointervention 1, August

11 1. Zeumer H, Hacke W, Ringelstein EB. Local intraarterial thrombolysis in vertebrobasilar thromboembolic disease. AJNR Am J Neuroradiol 1983;4: Tissue plasminogen activator for acute ischemic stroke. The national institute of neurological disorders and stroke rt-pa stroke study group. N Engl J Med 1995;333: Cho HK, Chung TS, Kim DI, Suh JH, Lee BI, Lee BC. Intracarotid urokinase thrombolytic therapy in acute cerebral infarction: A preliminary study. J Kor Radiol Societ 1990;26: Kim SY, Suh JH. Local intracranial intraarterial thrombolytic therapy in acute cerebral infarction. J Korean Radiol Soc 1996;34: Shi HB, Suh DC, Lim SM, Lee JH, Kim JK, Jeong AK, Choi CG, Lee HK, Lim TH, Auh YH. Outcome evaluation of intra-arterial infusion of urokinase for acute ischemic stroke. J Korean Radiol Soc 2000;42: Song JM, Yoon W, Kim JK, Seo JJ, Heo SH, Park JK, Jeong YY, Kang HK. Influential factors of clinical outcome of local intraarterial thrombolysis using urokinase in patients with hyperacute ischemic stroke. J Korean Radiol Soc 2002;47: Ng PP, Higashida RT, Cullen SP, Malek R, Dowd CF, Halbach VV. Intraarterial thrombolysis trials in acute ischemic stroke. J Vasc Interv Radiol 2004;15:S del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M. Proact: A phase ii randomized trial of recombinant prourokinase by direct arterial delivery in acute middle cerebral artery stroke. Proact investigators. Prolyse in acute cerebral thromboembolism. Stroke 1998;29: Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F. Intra-arterial prourokinase for acute ischemic stroke. The proact ii study: A randomized controlled trial. Prolyse in acute cerebral thromboembolism. Jama 1999;282: Intraarterial thrombolysis: Ready for prime time? Executive committee of the asitn. American society of interventional and therapeutic neuroradiology. AJNR Am J Neuroradiol 2001;22: Adams HP, Jr., Adams RJ, Brott T, del Zoppo GJ, Furlan A, Goldstein LB, Grubb RL, Higashida R, Kidwell C, Kwiatkowski TG, Marler JR, Hademenos GJ. Guidelines for the early management of patients with ischemic stroke: A scientific statement from the stroke council of the american stroke association. Stroke 2003;34: Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, Dillon W, Warach S, Broderick J, Tilley B, Sacks D. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003;34:e Bergui M, Bradac GB. Intra-arterial thrombolysis in late pregnancy. Stroke 2006;37:764; author reply Connors JJ, 3rd. Pharmacologic agents in stroke prevention, acute stroke therapy, and interventional procedures. J Vasc Interv Radiol 2004;15:S Ringleb PA. Thrombolytics, anticoagulants, and antiplatelet agents. Stroke 2006;37: Ouriel K. Comparison of safety and efficacy of the various thrombolytic agents. Rev Cardiovasc Med 2002;3 Suppl 2:S Zeumer H, Freitag HJ, Zanella F, Thie A, Arning C. Local intraarterial fibrinolytic therapy in patients with stroke: Urokinase versus recombinant tissue plasminogen activator (r-tpa). Neuroradiology 1993;35: Semba CP, Murphy TP, Bakal CW, Calis KA, Matalon TA. Thrombolytic therapy with use of alteplase (rt-pa) in peripheral arterial occlusive disease: Review of the clinical literature. The advisory panel. J Vasc Interv Radiol 2000;11: Torr SR, Nachowiak DA, Fujii S, Sobel BE. Plasminogen steal And clot lysis. J Am Coll Cardiol 1992;19: Kaur J, Zhao Z, Klein GM, Lo EH, Buchan AM. The neurotoxicity of tissue plasminogen activator? J Cereb Blood Flow Metab 2004;24: Noser EA, Shaltoni HM, Hall CE, Alexandrov AV, Garami Z, Cacayorin ED, Song JK, Grotta JC, Campbell MS, 3rd. Aggressive mechanical clot disruption: A safe adjunct to thrombolytic therapy in acute stroke? Stroke 2005;36: Nesbit GM, Clark WM, O Neill OR, Barnwell SL. Intracranial intraarterial thrombolysis facilitated by microcatheter navigation through an occluded cervical internal carotid artery. J Neurosurg 1996;84: Ohta H, Nakano S, Yokogami K, Iseda T, Yoneyama T, Wakisaka S. Appearance of early venous filling during intra-arterial reperfusion therapy for acute middle cerebral artery occlusion: A predictive sign for hemorrhagic complications. Stroke 2004;35: Qureshi AI, Siddiqui AM, Kim SH, Hanel RA, Xavier AR, Kirmani JF, Suri MF, Boulos AS, Hopkins LN. Reocclusion of recanalized arteries during intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol 2004;25: Cannon CP. Overcoming thrombolytic resistance: Rationale and initial clinical experience combining thrombolytic therapy and glycoprotein iib/iiia receptor inhibition for acute myocardial infarction. J Am Coll Cardiol 1999;34: Lewandowski CA, Frankel M, Tomsick TA, Broderick J, Frey J, Clark W, Starkman S, Grotta J, Spilker J, Khoury J, Brott T. Combined intravenous and intra-arterial r-tpa versus intra-arterial therapy of acute ischemic stroke: emergency management of stroke (ems) bridging trial. Stroke 1999;30: Combined intravenous and intra-arterial recanalization for acute ischemic stroke: The interventional management of stroke study. 28 Neurointervention 1, August 2006

Cho HK, Chung TS, Kim DI, Suh JH, Lee BI, Lee BC. Intracarotid urokinase thrombolytic therapy in acute cerebral infarction: A preliminary study. J Kor Radiol Societ 1990;26:609-617 4. Kim SY, Suh JH.

12 Stroke 2004;35: Lee KY, Kim DI, Kim SH, Lee SI, Chung HW, Shim YW, Kim SM, Heo JH. Sequential combination of intravenous recombinant tissue plasminogen activator and intra-arterial urokinase in acute ischemic stroke. AJNR Am J Neuroradiol 2004;25: Lee DH, Jo KD, Kim HG, Choi SJ, Jung SM, Ryu DS, Park MS. Local intraarterial urokinase thrombolysis of acute ischemic stroke with or without intravenous abciximab: A pilot study. J Vasc Interv Radiol 2002;13: Mangiafico S, Cellerini M, Nencini P, Gensini G, Inzitari D. Intravenous tirofiban with intra-arterial urokinase and mechanical thrombolysis in stroke: Preliminary experience in 11 cases. Stroke 2005;36: Kwon OK, Lee KJ, Han MH, Oh CW, Han DH, Koh YC. Intraarterially administered abciximab as an adjuvant thrombolytic therapy: Report of three cases. AJNR Am J Neuroradiol 2002;23: Nakano S, Iseda T, Yoneyama T, Kawano H, Wakisaka S. Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: An alternative option to intra-arterial thrombolysis. Stroke 2002;33: Coutts SB, Hill MD, Hu WY. Hyperperfusion syndrome: Toward a stricter definition. Neurosurgery 2003;53: ; discussion Imai K, Mori T, Izumoto H, Watanabe M, Majima K. Emergency carotid artery stent placement in patients with acute ischemic stroke. AJNR Am J Neuroradiol 2005;26: Nedeltchev K, Brekenfeld C, Remonda L, Ozdoba C, Do DD, Arnold M, Mattle HP, Schroth G. Internal carotid artery stent implantation in 25 patients with acute stroke: Preliminary results. Radiology 2005;237: Molina CA, Saver JL. Extending reperfusion therapy for acute ischemic stroke: emerging pharmacological, mechanical, and imaging strategies. Stroke 2005;36: Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi mechanical embolus removal in cerebral ischemia (merci) trial, part i. AJNR Am J Neuroradiol 2006;27: Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, Lutsep HL, Nesbit GM, Grobelny T, Rymer MM, Silverman IE, Higashida RT, Budzik RF, Marks MP. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: Results of the merci trial. Stroke 2005;36: Nesbit GM, Luh G, Tien R, Barnwell SL. New and future endovascular treatment strategies for acute ischemic stroke. J Vasc Interv Radiol 2004;15:S Schumacher HC, Meyers PM, Yavagal DR, Harel NY, Elkind MS, Mohr JP, Pile-Spellman J. Endovascular mechanical thrombectomy of an occluded superior division branch of the left mca for acute cardioembolic stroke. Cardiovasc Intervent Radiol 2003;26: Davis SM, Donnan GA. Merci retriever: Does it work? Stroke 2006;37: Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, Montaner J, Saqqur M, Demchuk AM, Moye LA, Hill MD, Wojner AW. Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med. 2004;351: Mahon BR, Nesbit GM, Barnwell SL, Clark W, Marotta TR, Weill A, Teal PA, Qureshi AI. North american clinical experience with the ekos microlysus infusion catheter for the treatment of embolic stroke. AJNR Am J Neuroradiol 2003;24: Yoon W, Seo JJ, Kim JK, Cho KH, Park JG, Kang HK. Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke. Stroke 2004;35: Neurointervention 1, August

Lee DH, Jo KD, Kim HG, Choi SJ, Jung SM, Ryu DS, Park MS. Local intraarterial urokinase thrombolysis of acute ischemic stroke with or without intravenous abciximab: A pilot study.

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical