动脉溶栓联合血管成形术治疗急性缺血性卒中的单中心研究

目的 总结急性缺血性卒中患者早期动脉溶栓联合血管成形术的经验,评价该方法治疗急性缺血性卒中的安全性和有效性.方法 回顾性分析首都医科大学宣武医院介入放射诊断治疗科2000年1月-2010年9月,行动脉溶栓联合血管成形术治疗的98例急性缺血性卒中患者的临床资料,评估其疗效、围手术期的并发症以及随访情况.结果 ①所有患者均在动脉溶栓后行血管成形术,技术成功率达100%,术后血管再通率达100%;②围手术期出现蛛网膜下腔出血5例,脑内血肿9例,动脉夹层8例,急性/亚急性再闭塞4例,前、后循环并发症的发生率以及出血性并发症的发生率比较,差异无统计学意义,P〉0.05;③所有患者术前NIHSS评分为16.1±3.8,术后90 dNIHSS评分为6.7±7.7,差异有统计学意义,P〈0.01;④术后90d预后良好者有60例,预后中等者有18例,预后差者有20例,其中死亡12例.后循环患者预后差的比例高于前循环患者（46.7%对8.8%）,差异有统计学意义,P〈0.01.后循环患者的病死率高于前循环患者（26.7%对5.9%）,差异有统计学意义,P〈0.01.结论 动脉溶栓联合血管成形术在技术层面上是可行的,可以提高早期血管再通率,改善患者的预后.

Intra-arterial thrombolysis combined with angioplasty for treatment of acute ischemic cerebral infarction

Abstract： Objectives To analyze the experiences of early intra-arterial thrombolysis combined with angioplasty for treatment of acute ischemic cerebral infarction and to assess its safety and efficacy. Methods The clinical data of 98 patients with acute ischemic cerebral infarction treated by intra-arterial thrombolysis combined with angioplasty in the department of interventional Radiology, Xuan Wu Hospital, Capital Medical University from January 2000 to September 2010 were analyzed retrospectively. Their effi- cacy, perioperative complications, and follow-up results were evaluated. Results ①All patients were successfully received intra-arterial angioplasty after intraarterial thrombolysis. The technical success rate was 100%, and the recanalization rate after procedure was also 100%. ②Five patients had perioperative subarachnoid hemorrhage, 9 had intracerebral hematoma, 8 had arterial dissection, and 4 had acute or subacute reoclusion. There was no significant difference of the incidence of complications and the incidence hemorrhagic complications between the anterior and posterior circulation （P 〉 0.05）. ③The National Institutes of Health Stroke Scale （NIHSS） score in all the patients before procedure was 16.1 ±3.8, and it was 6.7 ±7.7 at90 days after the procedure. There was significant difference （P 〈0.01）. ④ Sixty patients had good prognosis, 18 had moderate prognosis, and 20 had poor prognosis at 90 days after procedure, and 12 patients died. The proportion of poor prognosis in patients with posterior circulation infarction was higher than that in patients with anterior circulation infarction （46. 7% vs. 8.8% ）. There was significant difference （P 〈0. 01 ）. The mortality rate in pa-tients with posterior circulation infarction was higher than that in patients with anterior circulation infarction （26.7% vs. 5.9% ）. There was significant difference （P 〈 0.01 ）. Conclusion Thrombolysis combined with angioplasty are technical feasible for treatment of acute ischemic cerebral infarction, it may elevate the vascular recanalization rate and improve the prognosis of patients with intra-arterial thrombosis.