动脉溶栓联合血管支架成形术治疗急性脑梗死患者的疗效观察

目的 观察超选择性动脉溶栓联合血管内支架成形术治疗合并动脉狭窄的急性脑梗死的临床疗效及安全性。方法 选择2009年10月～2013年10月在西安交通大学第二附属医院神经内科对动脉溶栓[尿激酶或重组人组织型纤溶酶原激活剂(rt-PA)]再通后残存严重狭窄(狭窄率>70%)的18例急性脑梗死行血管内支架成形术治疗患者为研究对象,术后即刻血管造影评估支架定位及血管残余狭窄率。采用美国国立卫生研究院卒中量表(NIHSS)评分评估患者治疗前、后神经功能缺损程度,3月后应用改良Rankin量表(mRS)评分评估患者预后。术后电话或门诊随访,平均随访时间(18.18±10.37)(6～48)个月。结果 所有支架定位准确,血管残余狭窄率<20%。治疗后神经功能缺损程度评分较治疗前明显改善(P<0.05),3个月后mRS评分明显改善。1例(5.6%)在术后第4 d仍处于昏迷状态,家属放弃治疗,死于脑干梗死。1例(5.6%)术后10个月出现神经定位体征,但临床表现明显较首次发病轻,复查DSA提示支架处血管闭塞。结论 早期超选择性动脉内溶栓联合血管内支架成形术治疗合并动脉狭窄的急性脑梗死患者的方法安全、有效。

Clinical effects of intra-arterial thrombolysis combined with Angioplasty in patients with acute cerebral infarction

ObjectiveTo observe clinical safety and efficacy of super-selective intra-arterial thrombolysis combined with Angioplasty in acute cerebral infarction patients with arterial stenosis.Methods 18 patients with acute cerebral infarction combined with severe arterial stenosis were reviewed. All the patients underwent super-selective intra-arterial thrombolysis with vascular stenting. The brackets’ position and residual stenosis were identified after the treatment. National Institute of Health Stroke Scale(NIHSS)were expended to assess neurological deficits before and after the treatment. During the follow-up of 6 to 48 months(mean of 18.2 months),Modified Rankin Scale(mRS)were deployed to evaluate the prognosis at 3 months after the onset.Results All the brackets were located and residual stenosis were under 20% after the treatment. The neurological deficits assessed by NIHSS achieved conspicuous amelioration(P<0.05). And the patients procured benign prognosis was suggested by mRS. One patient died of brain stem infarction after 4-days exanimation. Another patient got a recurrence and was diagnosed as stent occlusion by digital subtraction angiography after 10 months.Conclusions super-selective intra-arterial thrombolysis combined with Angioplasty evident safety and efficacy in acute cerebral infarction patients with arterial stenosis.