Objective To investigate the effects of combined treatment with butylphthalein and alteplase on vascular recanalization and hemorrhagic transformation (HT) in patients with acute cerebral infarction (ACI).

Methods One hundred patients with ACI were selected, and randomly divided into the alteplase group (50 cases, treated with alteplase intravenous thrombolysis) and butylphthalide combination group (50 cases, treated with alteplase intravenous thrombolysis + butylphthalide) by the random number table method. The vascular recanalization rate, incidence of HT and the total effective rate were compared between two groups. The oxidative stress indicators, vascular endothelial function indicators and HT-related indicators before and after treatment were compared between two groups, and the drug safety was monitored.

Results The vascular recanalization rate in the butylphthalide combination group (41/50, 82.00%) was higher than that in alteplase group (30/50, 60.00%) (χ² = 5.88, P ＜ 0.05), and the incidence of HT (1/50, 2.00%) was lower than that in alteplase group (8/50, 16.00%) (χ² = 4.40, P ＜ 0.05). Moreover, the total effective rate (44/50, 88.00%) was higher than that of alteplase group (33/50, 66.00%) (χ² = 6.83, P ＜ 0.01). After treatment, the levels of superoxide dismutase, nitric oxide and vascular endothelial growth factor increased in two groups, while the levels of malondialdehyde, endothelin-1, matrix metalloproteinase-9 and neuron-specific enolase decreased. Moreover, which in the butylphthalide combination group was superior to the alteplase group (P ＜ 0.05).

Conclusions The addition of butylphthalide after intravenous thrombolysis with ateplase for acute ACI patients can effectively improve the vascular recanalization rate, control the incidence of HT, improve the overall treatment efficiency, and improve oxidative stress indicators, vascular endothelial function indicators, and HT related indicators. The safety is good and can be promoted for clinical use.