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Discussion on the treatment of cerebral ischemia-reperfusion injuries following intra-arterial thrombolysis

TIAN Hong, SONG Chuan, FAN Ru-xiong, ZHOU Hu-chuan, ZHANG Yu-bo, ZANG Qiao-li, ZHANG Yun-quan, LIU Lei. Department of Neurology, No.324 Hospital of PLA , Chongqing 400020, China  
Objective To investigate the therapeutic method of cerebral ischemia-reperfusion injuries occurred after arterial thrombolytic therapy for acute cerebral infarction. Methods Thirty-five patients, encountered in authors' Department since Oct. 2005, with cerebral ischemia-reperfusion injuries, which occurred after thrombolytic therapy by using arterial perfusion of urokinase lor acute cerebral infarction, were enrolled in this study. The clinical data were retrospectively analyzed. Results After the thrombolytic therapy, complete or partial recanalization of the occluded cerebral arteries was obtained in 33 cases, while secondary cerebral hemorrhage occurred in 13 cases, of whom cerebral parenchyma bleeding was seen in 2 and hemorrhagic infarction in 11. Different degrees of cerebral edema were found in all 33 cases. Among them significant shift of the midline structures was detected in 18 (54.5%), which was manifested clinically as the worsening of disturbance of consciousness. Strict control of blood pressure, prompt adjustment of dehydration medication, strengthening the cerebral protection measures, cerebral decompression by fenestration, etc. were carried out. All the patients took a turn for the better and were out of danger with remarkable improvement of neurological functions except one patient who died from massive intracerebral hemorrhage. Conclusion Usually, different degrees of reperfusion injuries will develop after thrombolytic therapy tor cerebral arterial infarction. Strictly controlling blood pressure, promptly adjusting dehydration medication and strengthening cerebral protection are the keys to reduce the severity of cerebral reperfusion injuries. (J Intervent Radiol, 2011, 20: 603-605)
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