静脉溶栓联合血管内治疗在前循环大血管狭窄导致的低灌注性脑梗死患者中的疗效和安全性观察

目的观察静脉溶栓联合血管内治疗在前循环大血管狭窄导致的低灌注性脑梗死患者中的疗效和安全性。方法回顾性纳入2017年3月-2019年3月在聊城市第三人民医院因单侧颈内动脉或大脑中动脉严重狭窄导致急性低灌注脑梗死患者,所有患者均给予标准剂量阿替普酶静脉溶栓联合多途径血管内治疗,随访术后2周、1个月和3个月的NIHSS及mRS评分。结果共纳入40例行静脉溶栓联合血管内治疗的急性低灌注脑梗死患者,其中男性24例(60%),平均年龄70±4岁(60～80岁)。治疗后患者血管狭窄程度较治疗前明显改善(中位数:18%vs 86%,P0.01),患者在术后2周、1个月及3个月的NIHSS和mRS评分均较治疗前降低(均P0.05)。在40例患者中,有1例(2.5%)术后发生大面积脑梗死及脑疝,另1例(2.5%)术后发生症状性颅内出血。结论静脉溶栓联合血管内治疗对于前循环大血管狭窄导致的急性低灌注性脑梗死患者有良好的临床疗效,并且相对安全,值得在临床上推广应用。

Intravenous Thrombolysis Combined with Endovascular Treatment for Hypoperfusion Cerebral Infarction Caused by Anterior Circulation Large Vessel Stenosis

Objective To preliminarily observe the efficacy and safety of intravenous thrombolysis combined
with endovascular treatment in patients with hypoperfusion cerebral infarction caused by anterior
circulation large vessel stenosis.
Methods Data of consecutive patients with hypoperfusion cerebral infarction caused by anterior
circulation large vessel stenosis from Liaocheng Third People's Hospital between March 2017 and
March 2019 were retrospectively analyzed. All enrolled patients received intravenous alteplase
combined with endovascular treatment (including mechanical thrombectomy and/or intra-arterial
thrombolysis and/or balloon angioplasty and/or stenting), and were followed up for 2 weeks, 1
month and 3 months after the procedure.
Results A total of 40 patients successfully completed intravenous thrombolysis combined with
endovascular treatment, with 24 (60%) males and a mean age of 70±4 (range 60-80) years old. The
postoperative stenosis degree of target vessel significantly improved compared with that before
operation (median: 18% vs 86%, P <0.01). The median scores of NIHSS and mRS at 2 weeks, 1 and
3 months after treatment were significantly lower than that before treatment (all P <0.05). Among 40
patients, only one (2.5%) patient had massive cerebral infarction and brain herniation, and another
(2.5%) had symptomatic intracranial hemorrhage on the next day after operation.
Conclusions Intravenous thrombolysis combined with endovascular treatment for hypoperfusion
cerebral infarction caused by anterior circulation large vessel stenosis may be effective and safe.