基底动脉闭塞动脉内溶栓的临床分析

目的 观察尿激酶(Urokinase)动脉内溶栓(IAT)治疗基底动脉闭塞的疗效及并发症,分析预后相关因素.方法 对26例发病后12h内的椎基底动脉系统血栓形成患者行IAT治疗.疗效评价在溶栓后24h及20d进行,分别进行神经功能缺损评分,临床疗效全面观察.结果 溶栓前2例为TIMI 1,24例为TIMI 0.溶栓后22例闭塞血管部分/完全再通,4例未再通.20例患者结果良好,6例不良结果,其中4例死亡.发病6h内IAT组与发病6～12h内IAT组疗效对比无显著差异.结论 尿激酶动脉内溶栓治疗基底动脉闭塞是安全有效的治疗手段.     

机械取栓联合动脉溶栓与单纯动脉溶栓治疗急性基底动脉闭塞的疗效对比

<正>急性基底动脉闭塞是神经内科急症之一,一旦发病,病死率极高,即使存活,也往往留有严重后遗症,成为家庭和社会的负担。据统计,全球每年因卒中死亡的人数590万左右,其中急性基底动脉闭塞导致的死亡约100万人,怎样减少该病的致死、致残率是迫切需要解决的问题。静脉溶栓作为急性期治疗颅内血管闭塞的常用方法,操作简便,耗时短,但血管的再通率低,预后效果欠理想,随着介入技术的提高     

急性基底动脉闭塞研究进展

急性基底动脉闭塞(basilar artery occlusion,BAO)是最严重的缺血性卒中类型,病死率可接近90%。自2014-09开始5大研究相继公布了较为一致的研究结果,在急性前循环缺血性卒中患者中,以机械取栓为主的血管内治疗可带来明确获益,对急性缺血性卒中的治疗迈进了一大步。但对于后循环急性缺血性卒中,目前缺乏充分的证据证实血管内治疗在BAO中的有效性。本文就BAO最新研究进展作一综述。     

椎-基底动脉闭塞性疾病的溶栓治疗

对后循环(椎-基底动脉系统)溶栓治疗的经验不多。Hacke等最早报道了后循环闭塞患者动脉溶栓治疗的研究,65例颅内段椎动脉或基底动脉近期闭塞的患者中2/3在24h内接受治疗。其中43例患者给予动脉溶栓(尿激酶-rt-PA或     

基底动脉支架内急性闭塞静脉加动脉介入溶栓抢救成功一例

患者男性,64岁,因"言语不利、左侧肢体活动不利20 d"于2006年7月21日入院.既往有高血压病史2年.入院查体:血压160/100 mm Hg(1 mm Hg=0.133 kPa),意识清楚,言语尚可,脑神经检查未见明显异常,颈软无抵抗.四肢肌力、肌张力正常,双下肢病理征可疑阳性.化验示血常规正常.人院后行全脑血管造影示基底动脉近心端狭窄95%,遂行球囊扩张及支架植入术,术后造影见基底动脉近心端狭窄消失,远端血流恢复正常.术后口服氯吡格雷75 mg/d、阿司匹林100 mg,每日3次,低分子肝素钙0.4 ml皮下注射1次/12 h(共2 d).     

基底动脉不全闭塞15例临床观察与预后

目的分析15例基底动脉不全闭塞患者的起病形式、临床表现、头MRI特点及预后,观察与不良预后相关的临床特点。方法所有患者均经头MRI证实为椎基底动脉系统新鲜梗死及可见基底动脉流空不良。14例可追溯出椎基底动脉的前驱缺血症状,7例以基底动脉的短暂缺血发作(TIA)入院,主要为发作性眩晕,视物异常。结果15例患者中死亡5例,植物、半植物状态生存2例,半自理3例,基本自理者5例。结论提示早期出现短暂发作性眩晕可能与更差的预后相关。     

动脉内溶栓联合支架治疗基底动脉闭塞临床报道

目的探讨溶栓后即刻置入支架的方法治疗急性椎基底动脉系统卒中溶栓术后血管重新闭塞的有效性和安全性。方法回顾性分析北京宣武医院2003年7月-2004年12月采用动脉内溶栓加支架置入治疗的7例脑卒中患者的临床资料，采用尿激酶超选择动脉溶栓，溶栓后对血管狭窄行支架成形术。结果7例溶栓后均再通。基底动脉尾段狭窄1例，主干狭窄4例，头段狭窄2例．动脉狭窄率平均为85％．即刻置入冠脉支架。置入支架后造影显示血管形态良好．残留狭窄率小于20％。术后复查点片状脑出血2例。术后症状好转或消失6例，围手术期死亡1例。结论超选择动脉溶栓联合支架治疗能够防止血管再闭塞及卒中复发，改善病人预后。     

基底动脉闭塞症41例临床分析

本文回顾2003-02-2005—02入住我院的41例基底动脉闭塞患者，就其临床表现及影像学等特点作如下分析。     

血管内治疗对不同病变性质急性基底动脉闭塞患者预后的影响

目的 评估血管内治疗对不同病变性质导致的急性基底动脉闭塞性脑卒中患者预后的影响。方法 连续回顾性分析2017-11—2021-11在苏州大学附属张家港医院（31例）和苏州大学附属第二医院（50例）行血管内治疗的急性基底动脉闭塞患者81例,按照有无基底动脉狭窄（BAS）分BAS组和无BAS组,比较2组患者的临床、影像、手术资料,对比分析2组的预后结局。对BAS组进一步按血管成形术分亚组,比较预后。结果 共纳入BAS组患者56例,无BAS组患者25例,其女性比例更高（48.0%vs19.6%,P=0.009）,BAS组的高血脂比例（25%vs 0,P=0.004）、吸烟比例（53.6%vs 24.0%,P=0.013）、入院低密度脂蛋白[2.96(2.60～3.59)vs 2.62(1.91～2.75),P=0.006]更高,BAS组患者pc-ASPECTS评分低于无BAS组患者[7(6～8)vs 8(7～8),P=0.01],采用血管内成形术BAS组更高（33.9%vs 8.0%,P=0.014）。2组的成功再灌注mTICI 2b～3、病变血管部位、穿刺-复流时间、rt-PA静脉溶栓率差...     

急性基底动脉闭塞的治疗进展

【摘要】 基底动脉闭塞病情重,致死率和致残率高,静脉溶栓、动脉溶栓治疗和机械取栓治疗是目前最常见的治疗方法。与静脉溶栓相比,动脉溶栓或机械取栓治疗血管再通率较高,且时间窗较静脉溶栓治疗宽,但目前的研究并未证实动脉溶栓或机械取栓治疗优于静脉溶栓治疗。桥接治疗是结合静脉溶栓与动脉溶栓或机械取栓的具有发展前景的一种治疗新模式,但其有效性还需要进一步证实。本文将对急性基底动脉闭塞相关的治疗方法：静脉溶栓、动脉溶栓、机械取栓治疗等做一综述,以促进对急性基底动脉闭塞血管再通治疗的认识。     

Emergent stent placement following intra-arterial thrombolysis for the treatment of acute basilar artery occlusion

Acute basilar artery occlusion (BAO) is a condition producing high rates of morbidity and mortality. Intravenous thrombolysis or intra-arterial thrombolysis are therapeutic options; however, the clinical outcomes remain poor. The purpose of the present study was to evaluate feasibility, safety, and efficacy of emergency stent placement following intra-arterial thrombolysis for patients with acute BAO. Thirty-six consecutive patients were treated for acute BAO using intra-arterial therapy from September 2004 to October 2009. Nine patients, with a Glasgow Coma Scale (GCS) score ranging from 8 to 12, underwent emergency stent placement following inadequate revascularization after thrombolysis. Neurological status prior to treatment was evaluated using the GCS score. Modified Rankin Scale (mRS) scores at 90 days post-treatment were used to assess functional outcome and we reviewed clinical records for frequency of procedure-related complications. Stents were deployed at the target lesion in all patients. Successful revascularization was achieved in eight of nine (88.9%) patients (residual stenosis <50%). The median GCS score prior to thrombolysis was 9 (range: 6-12) and prior to stent placement was 10 (range: 8-12). Four patients (44.4%) achieved good outcomes as determined by the mRS scale (0-2 at 90 days). Mortality was 33.3% in all procedures with one patient (11.1%) experiencing acute intrastent thrombus formation. No patient developed symptomatic intracerebral hemorrhage. Data from our small case series demonstrates that emergency stent placement following intra-arterial thrombolysis is a feasible treatment for patients with acute BAO and may reduce mortality and prevent re-occlusion of the basilar artery.     

Endovascular treatment of acute basilar artery occlusion: Outcomes,influencing factors and imaging characteristics from the Tama-REgistry of acute thrombectomy (TREAT) study

ObjectiveThe effectiveness of mechanical thrombectomy (MT) for acute basilar artery occlusion (ABAO) remains unknown. We evaluated the feasibility, safety, and efficacy of endovascular treatment for ABAO.MethodsWe retrospectively investigated patients with ABAO who underwent MT using modern stent retrievers and an aspiration device between January 2015 and March 2019 at 12 comprehensive stroke centers. Functional outcomes and 90-day mortality rates were analyzed as primary outcomes. Factors influencing outcomes were analyzed as secondary outcomes. Relationships between outcome and affected area of infarction on arrival were also analyzed.ResultsSeventy-three patients were included. Good outcome (modified Rankin Scale (mRS) score 0–2) was achieved in 25/73 patients (34.2%) and the all-cause 90-day mortality rate was 23.3% (17/73). Successful recanalization (modified Thrombolysis In Cerebral Infarction grade 2b and 3) was achieved in 70/73 patients (95.9%). In univariate analyses, age, National Institutes of Health Stroke Scale score, and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) differed significantly between good and poor functional outcome groups. Age and pc-ASPECTS were significantly associated with functional outcomes in the logistic regression model. Positive findings for the midbrain on diffusion-weighted imaging on pc-ASPECTS and brainstem score were significantly associated with poor outcomes.ConclusionMT with modern devices for ABAO resulted in highly successful recanalization and good outcomes. A positive finding for the midbrain on initial imaging might predict poor outcomes. Further studies are required to confirm our results.     

Mechanical thrombectomy with the Solitaire AB stent for treatment of acute basilar artery occlusion: A single-center experience

Basilar artery occlusion (BAO) remains one of the most devastating subtypes of ischemic stroke, and prognosis is poor if early recanalization is not achieved. The purpose of this study was to evaluate the safety and technical feasibility of mechanical thrombectomy with the Solitaire AB stent (Covidien, Irvine, CA, USA) for the treatment of acute BAO through a single-center experience. Twenty-one patients with acute BAO were treated with mechanical thrombectomy with the Solitaire AB stent device between 1st September 2011 and 1st December 2014. Recanalization was assessed using the Thrombolysis in Cerebral Infarction (TICI) scale system. Clinical outcome was established at discharge by The National Institute of Health Stroke Scale (NIHSS), and the mean time from symptom onset to recanalization determined. Authors had access to identifying information during or after data collection. The clinical status of patients on admission was severe, with a mean NIHSS score of 25.57 ± 5.20 (range: 16–38), and the number of patients with TICI 2b or 3 was 0. The mean time from symptom onset to recanalization was 579.00 ± 188.78 min (range: 360–960 min). At 3-month follow-up, eight (38.1%) patients had a good clinical outcome. At follow-up, the trial of ORG 10172 in acute stroke treatment (TOAST) classification was large-vessel atherosclerosis in 13 patients (61.9%), cardioembolic in seven patients (33.3%), and undetermined in one patient (4.8%). In our series, application of the Solitaire AB stent retriever in acute BAO resulted in a high recanalization rate without procedural complications, and with good clinical outcome. Further prospective trials are needed to confirm the potential clinical benefit of this treatment approach.     

Severe ethylene glycol intoxication mimicking acute basilar artery occlusion

We report a patient with severe ethylene glycol poisoning initially mimicking acute basilar artery occlusion and elucidate the importance of immediate diagnosis and treatment: a previously healthy 59-year-old truck driver presenting with hallmarks of basilar artery syndrome after having consumed an unknown substance. Immediate application of intravenous ethanol and hemodialysis could not prevent the development of a malignant brain edema within hours. This report describes a new clinical presentation of severe ethylene glycol intoxication mimicking acute basilar artery occlusion with the development of a fatal brain edema within hours, despite adequate treatment.     

急性脑梗死静脉溶栓早期治疗效果的多因素分析

目的 探讨影响脑梗死患者的基线情况与其静脉溶栓早期治疗效果的关系.方法 回顾性分析71例行静脉溶栓的急性脑梗死患者的临床资料,以静脉溶栓后24h的美国国立卫生院卒中量表(NIHSS)评分较溶栓前减少≥4分或神经功能缺损症状完全消失视为有效,比较有效组和无效组患者的年龄、性别、高血压病史、糖尿病病史、房颤、吸烟,发病至溶栓的间隔时间,溶栓前平均动脉压、溶栓前血糖、溶栓前纤维蛋白原、溶栓前NIHSS评分、溶栓药物类型,使用Logistic回归分析以上与溶栓早期治疗效果有关的因素.结果 静脉溶栓早期有效率为40.8％ (29/71).有效组在3h内接受溶栓的患者比率高于无效组(55.2％ vs 21.4％,P=0.003),而心房颤动的比率低于无效组(6.9％ vs 26.2％,P=0.039).Logistic回归分析显示发病至溶栓间隔时间(＜3 h)与早期神经功能障碍改善独立相关(OR =0.161,95％ CI:0.148-0.533,P=0.003),而心房颤动则是其危险因素(OR=8.666,95％ CI:1.482～ 50.688,P=0.017).结论 脑梗死急性期静脉溶栓早期治疗效果与发病至溶栓间隔时间及是否伴心房颤动相关.     

机械再通治疗基底动脉急性闭塞的疗效分析

目的观察机械再通基底动脉急性闭塞的疗效,探讨机械再通基底动脉急性闭塞的可行性和安全性。方法回顾性分析近4年采用血管内机械再通治疗基底动脉急性闭塞7例患者的临床资料,观察术后即时效果和预后。结果 7例患者均实现机械再通。其中,3例患者因血管狭窄50%行支架成形术,1例患者因血管狭窄50%未行支架成形术,另3例有房颤病史患者无明显血管狭窄。出血死亡2例,植物存活1例,另4例恢复良好。5例存活者3月后mRS评分分别为1分1例,2分1例,3分2例,5分1例。结论机械再通治疗基底动脉急性闭塞成功率高,总体效果满意,是有效、安全的治疗方法。     

Intravenous thrombolysis in patients with stroke attributable to small artery occlusion

Background: Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Recent observations raised concern that IVT might cause harm in patients with strokes attributable to small artery occlusion (SAO). Objective: The safety of IVT in SAO‐patients is addressed in this study. Methods:  We used the Swiss IVT databank to compare outcome and complications of IVT‐treated SAO‐patients with IVT‐treated patients with other etiologies (non‐SAO‐patients). Main outcome and complication measures were independence (modified Rankin scale ≤2) at 3 months, intracranial hemorrhage (ICH), and recurrent ischaemic stroke. Results: Sixty‐five (6.2%) of 1048 IVT‐treated patients had SAO. Amongst SAO‐patients, 1.5% (1/65) patients died, compared to 11.2% (110/983) in the non‐SAO‐group (P = 0.014). SAO‐patients reached independence more often than non‐SAO‐patients (75.4% versus 58.9%; OR 2.14 (95% CI 1.20–3.81; P = 0.001). This association became insignificant after adjustment for age, gender, and stroke severity (OR 1.41 95% CI 0.713–2.788; P = 0.32). Glucose level and (to some degree) stroke severity but not age predicted 3‐month‐independence in IVT‐treated SAO‐patients. ICHs (all/symptomatic) were similar in SAO‐ (12.3%/4.6%) and non‐SAO‐patients (13.4%/5.3%; P > 0.8). Fatal ICH occurred in 3.3% of the non‐SAO‐patients but none amongst SAO‐patients. Ischaemic stroke within 3 months after IVT reoccurred in 1.5% of SAO‐patients and in 2.3% of non‐SAO‐patients (P = 0.68). Conclusion: IVT‐treated SAO‐patients died less often and reached independence more often than IVT‐treated non‐SAO‐patients. However, the variable ‘SAO’ was a dependent rather than an independent outcome predictor. The absence of an excess in ICH indicates that IVT seems not to be harmful in SAO‐patients.