大脑中动脉闭塞的超选择动脉同溶栓治疗

目的：探讨超选择性动脉内溶栓治疗急性大脑中动脉闭塞的价值。方法：经股动脉穿刺,将微导管超选择插至闭塞血管远端或置于血块内注入尿激酶（UK）进行溶栓治疗,12名急性大脑中动脉闭塞患者接受了溶栓治疗。结果：8例获得大脑中动脉完全再通,3例获得部分再通,1例没有发生再通。随访5个月,6人生活能完全自理,2人生活部分自理,3人无法生活自理,1人死亡,结论：超选择性动脉内溶栓治疗可作为急性大脑中动脉闭塞可供选择的治疗方法之一。     

超选择性动脉溶栓联合血管内干预治疗急性缺血性脑卒中的临床探讨

目的探讨超选择性动脉溶栓联合血管内干预治疗急性缺血性脑卒中的疗效和安全性。方法回顾分析我院住院治疗的21例进行超选择性动脉溶栓的急性缺血性脑卒中患者的临床资料。结果21例患者中,颈内动脉系统病变16例．其中颈内动脉闭塞2例,大脑中动脉主干及分支闭塞6例,大脑前动脉闭塞1例,脑血管造影未见异常者7例。椎基底动脉闭塞5例,闭塞血管再通者,大脑中动脉4例,椎基底动脉2例。其中7例患者动脉溶栓的同时进行了血管内治疗,5例球囊成形术和2例支架植入术。临床症状完全恢复7例,明显好转或进步8例,无效3例,死亡3例;溶栓后脑出血2例．存活病例无1例并发脑出血及消化道出血。结论对选择的急性缺血性脑卒中患者进行超选择性动脉溶栓联合血管内干预治疗是安全有效的。     

经导管动脉内灌注尿激酶治疗急性脑动脉阻塞

目的 :探讨动脉血管内溶栓治疗急性脑动脉阻塞的疗效和价值。方法 :在DSA机下采用超选择性动脉插管灌注尿激酶治疗 48例急性脑动脉闭塞疾患。平均发病时间 2 9.6h ,尿激酶用量 80 0 0 0～ 3 0 0 0 0 0IU ,灌注时间持续 45～48min。结果 :6例患者即刻完全再通 ,3 8例部分再通 ,4例未通 ,临床有效率为 91.6%。结论 :超选择性动脉内灌注尿激酶是治疗急性脑动脉闭塞性疾病的优先选择方法。     

球囊碎栓辅助动脉溶栓治疗急性大脑中动脉闭塞

目的 评价利用抽瘪的球囊碎栓辅助动脉溶栓治疗急性大脑中动脉闭塞的可行性、安全性及疗效.方法 5例急性大脑中动脉闭塞患者接受球囊碎栓辅助动脉溶栓治疗.于颈内动脉远端充盈微球囊,抽瘪球囊沿微导丝通过血栓再退至血栓近端注入尿激酶,尿激酶最大剂量为50万u.结果 5例患者中3例获得完全再通,2例部分再通,均获得良好疗效.未见颅内出血并发症.结论 采用抽瘪的球囊碎栓辅助动脉溶栓足治疗急性大脑中动脉闭塞安全、可行、有效的方法.     

超选择性动脉溶栓治疗急性脑梗塞

目的：探讨急诊超选择性动脉溶栓治疗急性脑梗塞的价值和安全性。方法：对12例急性脑梗塞患者经股动脉插管，超选择至闭塞血管后，注入尿激酶行溶栓治疗。结果：颈内动脉闭塞4例，大脑中动脉闭塞8例。完全开通10例，2例部分开通。术后一周复查CT均未见大面积梗塞灶。1例发生术后脑出血。结论：早期超选择动脉溶栓是治疗急性脑梗塞最有效的方法之一。     

缺血性脑卒中超早期静脉溶栓治疗

目的 :评价超早期尿激酶静脉溶栓疗法对急性缺血性脑卒中的疗效和安全性。材料和方法 :随机选择 2 0例急性缺血性脑卒中患者 ,发病时间在 6h以内 ,半小时之内静脉滴注尿激酶 15 0× 10 4U/人 ,溶栓前、溶栓后 15min及 2 4h分别做血管造影检查 ,并记录比较患者溶栓前后临床神经功能缺损评分 (欧洲脑卒中评分 )及治疗 90天研究终点时的BarthelIndex和改良RankinScale。结果 :大脑中动脉闭塞 8例 ,6例完全再通 ,1例部分再通 ;大脑前动脉闭塞 1例 ,完全再通 ;颈内动脉闭塞 6例 ,3例部分开通 ,3例未通 ;豆纹动脉闭塞的 5例 ;4例临床完全恢复。本组病例中 2例继发症状性脑出血。有 3例患者死亡 ,死亡率为 15 %。结论 :超早期静脉溶栓可以使闭塞的血管再通 ,改善患者预后 ,但必需严格把握适应证 ,否则会增加脑出血的发病率及患者的死亡率。     

急性脑梗死患者超选择性局部动脉溶栓治疗

目的　观察超选择性动脉溶栓治疗急性脑梗死的安全性和疗效。方法　分析 6 1例超选择性局部动脉溶栓治疗的急性脑梗死患者 ,其中颈内动脉主干闭塞的 4例 (6 .6 % ) ,大脑中动脉主干及分支闭塞 4 8例 (78.7% ) ,大脑前动脉闭塞 5例 (8.2 % ) ,椎基底动脉闭塞 4例 (6 .6 % )。结果　预后好的患者共有 4 6例 (75 .4 % ) ,血管再通程度 >5 0 %的 4 4例 (72 .1% ) ,再通程度 <5 0 %的 17例 (2 7.9% )。颅内出血率 19.6 % ,病死率 6 .6 %。结论　超选择性局部动脉溶栓是一种有效的治疗方法 ,它可以提高血管再通率 ,改善脑梗死患者的预后。     

急性缺血性脑中风早期局部动脉内溶栓

目的　评价局部动脉内溶栓在急性缺血性脑中风治疗中的作用。方法　 11例急性缺血性脑中风患者 ,采用局部动脉内灌注尿激酶 (UK)溶栓 ,所有病例均在发病 10h内接受治疗。入院时平均脑中风评分 (NIHS)为 18分。均为大脑中动脉 (MCA)闭塞。术后 3 0d用RankinScale(RS)标准评估疗效。结果　 7例 (63 .6% )闭塞获得完全再通 ,1例 (9% )部分再通后并发颅内出血。 3例(2 7.3 % )无效。术后 3 0d ,2例 (18.2 % )完全恢复 (RS 0～ 1分 ) ,5例 (4 5 .5 % )轻度神经功能障碍 (RS 2～ 3分 ) ,4例 (3 6.3 % )重度神经功能障碍 (RS 4～ 5分 ) ,无死亡。结论　早期 (6h内 )局部动脉内溶栓是治疗急性缺血性脑中风的有效方法     

急性脑梗死动脉内溶栓治疗疗效观察

目的观察急性脑梗死患者行脑动脉内溶栓治疗的临床疗效。方法26例临床及头颅CT诊断为急性脑梗死患者用尿激酶行经动脉介入溶栓治疗(IATT)，治疗前后均作脑血管造影、复查CT及神经功能缺损评分。结果3例造影未见血管闭塞，23例患者即刻完全再通7例，部分再通11例，再通率78e。结论动脉溶栓疗法使84％的患者在15d内神经功能缺损得到改善，脑动脉内溶栓治疗是治疗急性脑梗死有效的方法之一。     

动脉内溶栓治疗急性缺血性脑梗死

目的　观察动脉内溶栓治疗急性缺血性脑梗死的临床效果 ,并分析影响预后的因素。方法　对 32例发病在 2～ 2 0h内的急性缺血性脑梗死患者进行动脉内溶栓治疗。尿激酶平均用量 6 5万U。患者病情在入院时由神经科医师以美国国立卫生研究院卒中分数 (NIHSS)综合评分。临床结果评价在溶栓后 3个月进行 ,按改良的Rakin分数 (MRS)分为好结果 (MRS 0～ 3)、差结果 (MRS 4～ 6 )两类。结果　灌注溶栓治疗后脑血管造影复查 ,闭塞血管再通率达 6 2 .5 % ,其中闭塞时间 6h内的 1 4例中 ,部分或完全再通 1 3例 ,闭塞时间在 6～ 2 0h的 1 8例中 ,部分或完全再通 7例。 2 0例患者 (6 2 .5 % )为好结果 ,1 2例 (37.5 % )为差结果 ,其中 2例死亡。 2例 (6 .2 5 % )发生症状性脑出血。良好的预后与入院时NIHSS评分 <2 0 (P <0 .0 1 )及血管再通 (P <0 .0 2 5 )密切相关 ,而血管再通又与开始溶栓时间 <6h有关 (P <0 .0 5 )。结论　动脉内溶栓治疗急性缺血性脑梗死是一种安全有效的方法 ,可使大部分患者闭塞动脉再通 ,提高临床治疗效果。血管闭塞时间越短 ,疗效越佳     

颅内动脉溶栓联合机械碎栓治疗急性脑梗死

目的探讨动脉溶栓联合机械碎栓治疗急性脑梗死的可行性和安全性。方法通过对9例急性脑梗死患者实施动脉内尿激酶溶栓联合机械性碎栓介入治疗(其中大脑前动脉A1段栓塞1例、大脑中动脉M1段栓塞6例、颈内动脉C1段狭窄1例、颈内动脉主干栓塞1例;起病距介入治疗时间3 h内2例,3～6 h 5例,>24 h 2例。结果7例6 h以内急性脑梗死患者主要栓塞血管得到100%开通,2例大于24 h患者症状得到改善(颈内动脉C1段狭窄1例、颈内动脉主干栓塞1例)。结论超选择局域性动脉内尿激酶溶栓联合机械碎栓治疗6 h以内急性脑梗死,能使闭塞的血管尽快开通,是一种安全有效的介入治疗术式。     

Intra-arterial thrombolysis of vessels supplying the brain

Intraarterial thrombolytic therapy can be life-saving in patients with vertebrobasilar occlusion. Thrombotic occlusions of the internal carotid artery or middle cerebral artery often result in disabling ischemic cerebral infarctions. Local fibrinolysis may help to minimize the neurological sequelae. Indications and contraindications for such a therapy are not yet well established, and more discussion is needed. During the last 2 years we have treated 18 patients with occlusions of vessels supplying the brain by means of local intraarterial thrombolytic therapy with urokinase. These included 5 patients who presented with internal carotid/middle cerebral artery occlusions, 3 of whom left the hospital with only minor neurological deficits while 2 died despite therapy. The other 13 patients had acute vertebrobasilar occlusion: 6 patients survived, 3 with a good general condition and 2 with locked-in syndrome. Technique, dosage of urokinase and patient selection are discussed as well as the outcome.     

Combined intraarterial/intravenous thrombolysis for acute ischemic stroke

BACKGROUND AND PURPOSE: The intravenous use of recombinant tissue-type plasminogen activator (rTPA) in acute ischemic stroke has been investigated in three large trials. Limited series have reflected outcome after local intraarterial thrombolysis (LIT) in the cerebral territory. The purpose of this study was to evaluate the safety and efficacy of combined intraarterial/intravenous thrombolysis using rTPA (actilyse) for acute ischemic stroke. METHODS: Forty-five patients with acute onset of severe hemispheric stroke and without signs of major cerebral infarction on early CT scans were randomized by order of admission. Twelve patients were treated with 50 mg actilyse (maximal dose, 0.7 mg/kg); three had occlusion of the internal carotid artery and nine had occlusion of the middle cerebral artery. Thrombolysis was started by LIT and continued intravenously within 6 hours of stroke onset. Outcome, assessed after 1 and 12 months according to the modified Rankin scale (MRS), was considered good (MRS score, 0-3) for patients who were functionally independent and poor (MRS score, 4-5) for those who were dependent or had died. RESULTS: In the thrombolysis group, outcome was good in eight patients at 1 month and in 10 patients at 12 months; in the control group, outcome was good in seven (21%) and 11 (33%) patients, respectively. Of the eight patients with a good outcome after thrombolysis, four had complete and one had partial recanalization. In the control group, the rate of intracerebral hemorrhage was 6%. Mortality at 1 month in the thrombolysis and control groups was 17% and 48%, respectively. CONCLUSIONS: Combined intraarterial/intravenous thrombolysis with low-dose rTPA may be a safe and effective treatment for acute ischemic stroke within 6 hours in carefully selected patients.     

Endovascular treatment for acute thrombotic occlusion of the middle cerebral artery: local intra-arterial thrombolysis combined with percutaneous transluminal angioplasty

We report our experience in treating 15 patients with acute thrombotic occlusion of the M1 or M2 segment of the middle cerebral artery who underwent intra-arterial thrombolytic therapy alone or in combination with percutaneous transluminal angioplasty (PTA). The results were compared with those of 30 patients with acute embolic occlusion of the same artery. Intra-arterial thrombolysis was performed in 10 patients and thrombolysis combined with PTA in 5 in whom symptoms reappeared due to restenosis or reocclusion, or in whom recanalisation was not successfully accomplished by thrombolysis alone. In the patients with embolism recanalisation was observed in 28 (93 %) and there was no patient with reocclusion. In the patients with thrombosis recanalisation immediately after thrombolysis alone was observed in 9 of 15 (60 %). Restenosis, with reappearance of symptoms, occurred in 2 of these (22 %). In the patients who also underwent PTA, angiography after 1 month did not demonstrate any restenosis or reocclusion. Thrombolysis combined with PTA for acute thrombotic stroke may provide an effective procedure for restoring patency and preventing reocclusion of the occluded artery. Received: 31 August 1995 Accepted: 20 March 1996     

急性缺血性脑梗死动脉介入溶栓治疗临床疗效观察

目的 探讨急性缺血性脑梗死经动脉溶栓的治疗效果。方法 采用尿激酶(UK)对19例急性缺血性脑梗死病人行动脉溶栓治疗，并行临床疗效判定及DSA再通判定。结果 19例患者中临床总有效率为89．5％，DSA再通率为89．5％，有些病人即使闭塞血管未完全再通但临床症状和体征也有好转。1例溶栓中引发脑出血，在短时间内吸收。结论 动脉溶栓是安全、有效的方法，但需注意治疗的个体化和预防并发症。     

Direct percutaneous transluminal angioplasty for acute middle cerebral artery occlusion.

PURPOSEWe review our initial experience with direct percutaneous transluminal angioplasty (PTA) as a reperfusion treatment for acute occlusion of the middle cerebral artery.METHODSTen patients in whom successful thrombolysis might not be expected because of the risk of hemorrhagic complications or reocclusion were treated with direct PTA. When early ischemic findings were present on the initial CT scans and/or when lenticulostriate arteries were involved, we performed direct PTA rather than thrombolytic therapy. Direct PTA was also performed when superselective local angiography via a Tracker catheter advanced just distal to the occlusion site showed the presence of a large embolus or high-grade stenosis suggestive of thrombosis. Angioplasty was performed with a Stealth balloon catheter with a maximum diameter of 2.0 to 2.5 mm. The balloon catheter was advanced into the site of occlusion and inflated to 2 atm initially, and subsequently up to 3 atm. Two to six inflations, each of 30 seconds'' duration, were performed.RESULTSAlthough the rate of initial recanalization was 100% (10 of 10), reocclusion occurred in two patients with atherothrombotic M2 occlusion. The final angiographic success rate of direct PTA was 80% (8 of 10). There were no hemorrhagic or technical complications, and five of 10 patients showed marked clinical improvement. In two of seven patients with cardioembolic M1 trunk occlusion, crushed fragments of the embolus obstructed M2 portions after direct PTA, necessitating local thrombolysis.CONCLUSIONDirect PTA may be performed safely as an alternative to thrombolytic therapy in patients with acute occlusion of the middle cerebral artery when early CT findings and/or lenticulostriate artery involvement are present or when superselective local angiography shows the presence of a large embolus or high-grade stenosis.     

超早期脑梗死的动脉内接触性溶栓

目的 探讨急性脑梗死的动脉内超早期溶栓治疗。方法 对１９９６年８月～２０００年２月用尿激酶进行超早期（发病至溶栓时间〈６ｈ）动脉内抵触性溶栓治疗１７例急性梗死病例进行回顾性分析。结果 １７例病人血栓或栓子位置分别为：大脑中动脉Ｍ１段１０例,大脑前动脉Ａ段１例,大脑后动脉Ｐ段１例,椎－基底动脉５例。溶栓后血管再通１５例,但１１例有残余狭窄。临床症状完全恢复者１２例,部分恢复者３例,死亡２例,结论 超     

Diagnostic angiography using multi-slice spiral CT in acute obstruction of the basilar artery

OBJECTIVE: To evaluate the diagnostic efficiency of CT angiography in case of clinical signs of acute brainstem infarction for the therapeutic management of catheter-based local thrombolysis. MATERIAL AND METHODS: 3 patients (2 males, 1 female) suffering from an acute onset of brainstem symptoms and being suspicious of an occluded basilar artery were included into this report. 1 patient underwent selective vertebral arteriography. 2 patients were initially examined with CT angiography using a 4-row scanner and 100 ml intravenous contrast agent. RESULTS: In one patient, an occlusion of the basilar artery was excluded with catheter-based angiography. Subsequently, the patient was treated with systemic thrombolysis using r-tPA because of a thalamus infarction seen in MRI. 2 patients who have been initially examined with CT angiography presented with complete occlusions of the basilar arteries. These patients underwent r-tPA thrombolysis by means of superselective micro-catheter approaches of the vertebrobasilar vessels. CT angiography was very useful for determinating the occlusion length of the basilar artery pre-therapeutically, and in 1 case for ruling out an occluded vertrebral artery for catheterization. All patients recovered well under thrombolytic therapy applied systemically or selectively. CONCLUSION: Cerebral multi-slice CT angiography is a fast and save technique for detecting or ruling out an acute basilar artery occlusion. Thus, in cases of equivocal clinical signs CT angiography is recommended before the decision of thrombolytic therapy is made.     

动脉内接触性溶栓治疗急性脑梗死时间窗选择与疗效分析

目的 探讨动脉内接触性溶栓治疗急性脑梗死的时间窗选择与疗效的关系.资料与方法 245例脑梗死均在CT检查及血管造影基础上接受选择性动脉内接触性溶栓治疗,其中在发病后6 h以内溶栓者56例,6～24 h溶栓者189例.分析两组患者的血管再通率和90天预后.结果 脑血管造影发现颈内动脉(ICA)系统闭塞173例,椎基底动脉(VBA)系统闭塞72例;溶栓后ICA系统再通113例,VBA系统再通37例.治疗后90天预后好者180例,预后差者65例.溶栓后颅内出血12例.6 h内组和6～24 h组患者血管内溶栓治疗后90天预后良好率分别为80.35 %(45/56)和71.43 %(135/189),血管再通率分别为66.07%(37/56)和59.79%(113/189),血管再通中位时间分别为67 min和73 min.结论 动脉内接触性溶栓可以明显改善脑梗死患者的预后,仅以发病时间不超过6 h作为动脉内溶栓治疗标准不够全面,应当根据病情适当放宽动脉内溶栓的时间窗.