Treatment efficacy of arterial urokinase thrombolysis combined with mechanical thrombectomy for acute cerebral infarction and its influence on neuroprotective factors and factors for neurological injury

Jingfeng Liu; Ling Tian; Na Li

Treatment efficacy of arterial urokinase thrombolysis combined with mechanical thrombectomy for acute cerebral infarction and its influence on neuroprotective factors and factors for neurological injury

Am J Transl Res. 2021 Apr 15;13(4):3380-3389. eCollection 2021.

Authors

Jingfeng Liu¹, Ling Tian², Na Li¹

Affiliations

¹ Department of Interventional Vascular Surgery, Affiliated Hospital of Hebei University Baoding, Hebei Province, China.
² Department of Nephrology, Affiliated Hospital of Hebei University Baoding, Hebei Province, China.

PMID: 34017513
PMCID: PMC8129294

Abstract

Objective: This study was designed to explore the treatment efficacy of arterial urokinase thrombolysis combined with Solitaire AB stent for acute cerebral infarction (ACI) and its influence on neuroprotective factors and factors for neurological injury.

Methods: We randomly assigned 90 patients with ACI to receive arterial urokinase thrombolysis combined with Solitaire AB stent thrombectomy (observation group, OG) or to receive arterial urokinase thrombolysis (control group, CG). The two groups were compared in the National Institutes of Health Stroke Scale (NIHSS) score, activities of daily living (ADL) score, vascular recanalization rate 1 month after treatment, and serum levels of neuroprotective factors (insulin-like growth factor-I (IGF-1), neurotrophic factor (NTF), vascular endothelial growth factor (VEGF), and brain-derived neurotrophic factor (BDNF)) and factors for neurological injury (neuron-specific enolase (NSE), S100B protein (S100B), ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), glial fibrillary acidic protein (GFAP)) before treatment and the day after treatment.

Results: The overall treatment response rate and vascular recanalization rate 1 month after treatment were markedly higher in OG than in CG (P<0.05). The NIHSS score decreased and the ADL score in both groups increased after treatment, with a lower NIHSS score and a higher ADL score in OG than in CG (all P<0.001). The difference in the complication rate between the two groups was not statistically significant (P>0.05). The day after treatment, serum levels of IGF-1, NTF, VEGF, and BDNF in both groups increased while levels of NSE, S100B, UCH-L1, and GFAP in them decreased, with higher levels of IGF-1, NTF, VEGF, and BDNF, and lower levels of NSE, S100B, UCH-L1, and GFAP in OG than in CG (all P<0.05).

Conclusion: Arterial urokinase thrombolysis combined with Solitaire AB stent thrombectomy can enhance the treatment efficacy for ACI, stimulate the release of neuroprotective factors, and suppress the release of factors for neurological injury, without aggravating the treatment risk.

Keywords: Arterial urokinase thrombolysis; Solitaire AB; acute cerebral infarction; neurological injury.