动静脉联合溶栓治疗大脑中动脉闭塞引起的急性缺血性脑卒中

目的研究动静脉联合溶栓治疗大脑中动脉闭塞引起的急性缺血性脑卒中的安全性和有效性。方法回顾分析我院采用静脉溶栓或动静脉联合溶栓病例23例。卒中严重程度采用NIHSS评分评估,CTA,MRA或全脑血管造影评估再通情况,溶栓治疗后72 h内观察溶栓后非症状性和症状性出血,临床预后通过改良RS评分进行评估。结果静脉溶栓组14例,动静脉联合溶栓组9例,两组患者入院后NISS评分无统计学差异,动静脉联合溶栓后大脑中动脉再通率明显高于静脉溶栓组(77.8 vs.28.6%,P=0.036),而术后出现症状性及非症状性颅内出血与静脉溶栓比较无明显差异,90 d达到mRS 0-2分患者比例与静脉组比较无统计学差异,联合溶栓组高于静脉组。结论与静脉溶栓比较,应用动静脉联合溶栓治疗大脑中动脉闭塞引起的急性缺血性脑卒中是一种安全、有效的方法。

Safety and efficacy of combined IV-IA thrombolysis in acute ischemic stroke patients with MCA occlusion

Objective To study the safety and efficacy of combined intravenous-intraarterial （ IV-IA） thrombolysis to intravenous thrombolysis （IVT） alone in acute ischemic stroke （ IS） patients with occluded middle cerebral artery （MCA）.Methods 23 consecutive IS patients with MCA occlusion were treated either with IVT alone or with IV-IA thrombolysis .Stroke severity was evaluated using NIHSS,achieved recanalizations using CTA ,MRA or angiography .Occurrence of ICH including SICH was evaluated after 72 hours.90-day clinical outcome was evaluated using modified Rankin Scale （mRS）.Results Group IVT consisted of 14 patients （9 males,mean age 67.6 ＆#177;11.9 years） and Group IV-IA of 9 patients （5 males,mean age 64.1 ＆#177;10.9 years）.No difference was found in the initial NIHSS and other baseline parameters .Patients treated with bridging therapy had a higher number of achieved MCA recanalization （77.8 vs.28.6%,P=0.036）,similar number of SICH and mRS0-2 versus patients treated with IVT .Conclusion Bridging IV-IA thrombolysis seems to be safe and more effective than IVT alone in acute stroke patients with MCA occlusion .