<International Circulation>：So that kind of answers my next question of whether this is kind of a last resort after thrombolytic Therapy. So how are you choosing these patients?

　　《国际循环网》：我下一个问题是，这是否是除溶栓治疗外最后的救命稻草呢？您是如何筛选适合这种手术的患者？
　　Kaste Markku：Normally you choose them based on their clinical symptoms and the second thing is their imaging symptoms. You can see quite often in a plain ECT that the whole middle cerebral artery is occluded. In an ordinary ECT， if the slices are in the proper place， you can see that the middle cerebral artery is occluded. But nowadays it is very easy to continue ECT with an ECT angiography. Or start with a MRI and MRI Angiography and if you see the whole inter carotid artery is occluded， or the middle cerebral artery of occluded， or even worse there is something called T-occlusion which means that the intracerebral cerebral artery and the anterior cerebral artery and the inter carotid artery are occluded. It’s so obvious. You can be almost one hundred percent sure that tPA is not going to take all these arteries because the size of the thrombi is huge. The dose is 0.9 per kg t-PA body weight; it’s not going to eat all that away. Then it’s time to call intra-arterial treatment. It’s possible to also use intra-arterial treatment. If IV treatment fails it’s possible to use this treatment. But now these mechanical thrombectomy devises and now it’s the way to go at the moment. So if you see this patient is unlikely to be reanalyzed you can start the IV treatment while the angio-lab is made available for the patient because at least it’s possible the IV treatment can do even just a little bit for the thrombi. There is not also another possibility which is to use ultrasound. So with the ultrasound you can see the thrombi through your skull. It is possible to see it through your skull with the ultrasound. Then you give the treatment and use the ultrasound at the same time. So the ultrasound may make the thrombi a little softer， easy for the t-PA and the t-PA can penetrate inside the thrombi. Not only for the occluded place， but also inside. Then also there is this treatment has been even extended. It’s not investigational. There are ongoing studies to see if it is possible to give patients together with the t-PA， microbubbles which are small bubbles of air. And then the ultrasound in a way blows those tiny bubbles which are already inside the thrombi. This makes it easier and faster for the t-PA to eat it away. So there have been these kinds of studies and now there have ongoing studies about these treatments in the United States and Europe together. Is this ultrasound and microemboli connected with t-PA? Is this more effective than t-PA alone?

　　Kaste Markku：通常选择患者主要基于临床症状和影像学表现。从ECT平片你可以清楚看到整个大脑中动脉阻塞。普通ECT如果扫描位置合适，你可以看到大脑中动脉阻塞。但现在ECT血管造影很容易。或进行MRI和MRI血管造影，你可以看到整个颈动脉阻塞，或整个大脑中动脉阻塞，或更糟糕的出现Ｔ型动脉阻塞，即脑内动脉、大脑前动脉和颈内动脉阻塞。这些动脉阻塞太大，tPA不可能适用于所有动脉阻塞。t-PA溶栓剂量是0.9/kｇ，但效果不一定好，这时行动脉内介入治疗。如果静脉内药物治疗失败，应用动脉内介入治疗可能性是有的。现在是利用血栓切除术的时候了。你可以先对患者行静脉内治疗，然后将患者转移至血管实验室，由于血管内治疗可能对血栓溶解起很小作用。还有另一种方法是利用超声发现血栓，治疗同时利用超声，可以使血栓更柔软，利于t-PA溶解血栓，不仅对阻塞部位有效，对于阻塞以内也有效。有试验正在研究是否给予患者t-PA同时给予微气泡，然后利用超声波击碎存在于血栓中的微气泡，使t-PA更容易快速溶解血栓。以上就是美国和欧洲的相关研究进展。这是超声和微气泡与t-PA的联合疗法吗？比单独应用t-PA更有效果吗？
 

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