急性缺血性脑梗死动脉内溶栓临床疗效评价

目的评价尿激酶动脉内溶栓治疗急性缺血性脑梗死的临床疗效。方法对162例急性缺血性脑梗死患者应用尿激酶进行局部动脉内溶栓治疗,分析不同阻塞血管部位血管再通率和3个月后格拉斯哥预后评分(GOS)之间的关系。结果脑血管造影发现血管闭塞162例,其中颈内动脉系统闭塞119例(73.5%):颈内动脉(ICA)主干闭塞27例(16.7%),大脑中动脉(MCA)闭塞63例(38.9%),大脑前动脉(ACA)闭塞29例(17.9%);椎基底动脉(VBA)闭塞43例(26.5%)。溶栓后再通分别为11例,40.7%;49例,77.8%;20例,68.9%和23例53.5%。治疗后3个月恢复良好者90例(55.6%),预后差72例(44.4%)。颅内出血8例(4.9%);再灌注损伤73例(45.1%);再栓塞6例(3.1%)。分析后认为ICA主干、VBA动脉再通率较低,预后差;MCA、ACA再通率高,预后好;开始治疗时间血管再通率和临床疗效相关(相关系数r=0.86)。结论局部动脉溶栓可以明显改善脑梗死患者的预后;预后和开始治疗的时间、血管再通有相关性,大脑中、前动脉血管再通率高,预后较好;颈内动脉主干血管阻塞很难再通;椎基底动脉血管再通后症状有所改善;血管不能再通或并发脑出血预后较差。     

动、静脉结合r-tPA溶栓治疗早期脑梗死

目的 评价动、静脉结合r-tPA溶栓治疗急性脑梗死的方法和临床疗效.方法 共15例急性脑梗死患者,术前均行CT、MR 和DSA检查证实颅内动脉闭塞部位：M1段4例,M2段2例,M3、4段2例,A1、2段1例,颈内动脉2例, P1段1例,豆纹动脉1例,其他穿支2例.其中术前经DSA证实12例.溶栓治疗时间在发病后3～7 h,采用动脉内药物灌注和机械疏通相结合方法溶栓,另外经静脉术前和术后持续滴注r-tPA辅助.术后观察临床症状和影像表现.结果 15例患者溶栓治疗中微导管和溶栓导管均到位满意,DSA所示闭塞段血管均有效再通.术后CT检查发现片状渗血2例,异位脑梗死1例.术后肢体功能即刻明显改善6例.临床观察3个月,症状基本完全恢复6例,较好改善7例,2例无明显改善;生活能力完全自理13例,有效率达87%（13/15）,生活能部分自理者1例,失去生活自理能力 1例,无患者死亡.结论 动、静脉结合溶栓治疗急性颅内动脉栓塞是一种有效、安全的治疗方法;局部动脉内灌注和机械疏通有效结合以及术前各项影像学检查的综合分析,将有利于动脉溶栓治疗的进行.     

经微导管自体动脉血转流在急性脑梗死动脉溶栓中的应用

目的 探讨经微导管自体动脉血转流技术在急性脑梗死动脉溶栓中应用的可行性.方法 6例发病6 h内急性脑梗死患者动脉溶栓治疗过程中,采用经微导管自体动脉血转流技术.在常规动脉溶栓开始前,将微导管通过血栓,经穿刺部位抽取股动脉血20 ml,经微导管于2 min内将其注入闭塞远端血管内,然后进行常规动脉溶栓操作.常规动脉溶栓与动脉血灌注每30 min交替1次.结果 溶栓术中动脉血转流1～5次,平均3次,每例患者转流操作所用时间平均为(8.0±3.2)min.6例患者动脉溶栓均再通,1例术后出现少量蛛网膜下腔出血.术后90 d,生活状态优4例、良2例.结论 经微导管自体动脉血转流技术,不干扰常规溶栓操作,未明显延长手术时间,可能对保护缺血脑组织具有一定作用,在急性脑梗死动脉溶栓中可予应用.     

急性颈内动脉系统脑梗死的局部动脉溶栓治疗

目的　检验局部注射尿激酶动脉溶栓治疗急性颈内动脉系统脑梗死的安全性和疗效。方法　分析 5 4例接受局部动脉溶栓治疗的颈内动脉系统急性脑梗死患者 ,其中颈内动脉主干闭塞 3例(5 .6 %) ,大脑中动脉主干及分支闭塞 46例 (85 .2 %) ,大脑前动脉闭塞 5例 (9.2 %)。结果　预后好的患者共有 41例 (75 .9%) ,血管再通程度 >5 0 %39例 (72 .2 %) ,再通程度 <5 0 %的 15例 (2 7.8%)。颅内出血率为 2 0 .4%,病死率为 7.4%。结论　局部动脉溶栓是一种有效的治疗方法 ,可以提高血管再通率 ,改善脑梗死患者的预后。     

Combined interventional stroke therapy using intracranial stent and local intraarterial thrombolysis (LIT)

Introduction  

Supported by results of the ECASS III study, intravenous rt-PA thrombolysis is considered a standard therapy for acute stroke within 4.5 h. Still under debate is the use of a more aggressive treatment as that of local intraarterial thrombolysis (LIT) or combining intravenous administration of recombinant tissue plasminogen activator (rt-PA) followed by LIT (bridging concept). Mechanical thrombus removal devices and effective flow achievement by stenting are reported to increase the recanalization rate and patient outcome. Newer reports showed the use of intracranial stents as the latest trend-setting technique. A combined approach hereby appears to achieve the best results consisting of pharmacologic thrombolysis, manual aspiration devices and stenting. We employed a novel removable stent as a new approach in acute stroke, aiming to make the intraarterial thrombolysis through an enhanced thrombus contact surface more effective and to reduce the effective revascularisation time with the possibility of stent removal after re-opening the occluded vessel.     

Internal carotid artery stent implantation in 25 patients with acute stroke: preliminary results

PURPOSE: To evaluate retrospectively the outcome for patients with acute ischemic stroke in the territory of the middle cerebral artery (MCA) who had undergone stent implantation in the proximal segment of the internal carotid artery (ICA) in addition to intraarterial thrombolysis (IAT). MATERIALS AND METHODS: Stent implantation and retrospective analysis of clinical and radiologic data were approved by the institutional ethical committee. Endovascular treatment was performed after obtaining informed consent from patients or their closest relatives. Informed consent for retrospective review was not required. After pharmacologic and/or mechanical IAT, 25 consecutive patients (seven women, 18 men; mean age, 59 years +/- 14 [standard deviation]) underwent stent implantation in the proximal segment of the ICA (endovascular group). The clinical and radiologic characteristics (ie, interval from symptom onset to arrival at the emergency department, prevalence of vascular risk factors, causes of stroke, stroke severity, early signs of cerebral ischemia, duration of endovascular intervention, type of occlusion, and prevalence of leptomeningeal collateral vessels), recanalization rates, and clinical outcomes for patients in the endovascular group were compared with those for patients in the medical group (10 women, 21 men; mean age, 62 years +/- 12) who experienced ischemic stroke in the territory of the MCA as a result of ICA occlusion and who received antithrombotic treatment only. Differences between groups were assessed by using the chi2 test. A logistic regression analysis was performed to assess the effect of clinical and radiologic factors on recanalization rates and outcome. RESULTS: ICA recanalization was successful in 21 patients. Good recanalization of the MCA was achieved in 11 patients. In nine of these patients, recanalization of the MCA was achieved by using mechanical IAT only. In the remaining 12 patients, administration of intraarterial urokinase was performed in addition to mechanical thrombolysis. Two patients from the endovascular group experienced symptomatic intracerebral hemorrhage. At 3 months, 56% of the endovascular group and 26% of the medical group had a favorable outcome. Mortality was 20% in the endovascular and 16% in the medical group. CONCLUSION: IAT and stent implantation in the proximal segment of the ICA seem to improve the outcome for patients with ischemic stroke caused by occlusion of the cervical portion of the ICA.     

Intravenous glycoprotein IIb/IIIa inhibitor (tirofiban) followed by intra-arterial urokinase and mechanical thrombolysis in stroke

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate preliminarily the efficacy and safety of intravenous tirofiban combined with intra-arterial pharmacologic and mechanical thrombolysis in patients with stroke. METHODS: Twenty-one consecutive patients with an acute ischemic stroke due to major cerebral arteries occlusion and a National Institutes of Health Stroke Scale [NIHSS] score > or = 18 were treated with an intravenous bolus of tirofiban and heparin followed by intra-arterial administration of urokinase coupled with mechanical thrombolysis. RESULTS: Thirteen patients had an anterior circulation stroke (T-siphon internal carotid artery [ICA] = 7; middle cerebral artery [MCA] = 6), 6 patients a posterior circulation stroke, and 2 patients an anterior plus posterior circulation stroke (left ICA or M1 tract of MCA plus basilar artery occlusions). Mean NIHSS score on admission was 21 (range, 18-27). Immediate recanalization was successful (thrombolysis in myocardial infarction [TIMI] 2-3) in 17 of 21 patients. The following day, 14 of 19 patients improved substantially and complete vessel patency (TIMI 3-4) was confirmed by digital subtraction angiography. Intracranial bleeding occurred in 5 of 21 patients (3 symptomatic cerebral hemorrhages and 2 subarachnoid hemorrhages) and was fatal in the case of 3 patients. At discharge, the mean NIHSS was 5.4 (range, 0-25). Overall, at 3-month follow-up the functional outcome was favorable (modified Rankin Scale score = 0-2) in 13 of 21 (62%) patients. Death (including all causes) at 90 days occurred in 6 of 21 (28%) cases. CONCLUSIONS: The combination of intravenous tirofiban with intra-arterial urokinase and mechanical thrombolysis may be successful in reestablishing vessel patency and result in a good functional outcome in patients with major cerebral arteries occlusions.     

急诊动脉内溶栓治疗急性缺血性脑梗死

目的 观察急诊动脉内溶栓（intra-arterial thrombolysis,IAT)治疗急性缺血性脑梗死的疗效及并发症，分析预后相关因素。方法 对25例发病在6h内的急性缺血性脑梗死患者行IAT治疗。血管再通程度根据“急性心肌梗死溶栓标准”（TIMI）分类。临床结果评价在溶栓后30d进行，根据改良的Rank分数（MRS）分为好结果（MRS0－3）、差结果（MRS4－6）两类。结果 溶栓前18例（72％）患者为TIMI0-1,7例（28％）为TIMI2。溶栓后13例（72％）患者部分／完全再通，5例（28％）未再通。18例患者（72％）为好结果，7例（28％）为差结果，其中4例死亡。发生症状性脑出血4例（16％）。结论 急诊动脉溶栓是可行安全的，溶栓前侧支循环、再通及溶栓后24h神经学检查上的提高（NI）与好结果密切相关，无再通与脑出血及死亡密切相关。提高动脉内溶栓临床效果的关键在于提高再通率。     

Intraarterial thrombolysis for treatment of acute stroke: experience in 26 patients with long-term follow-up.

BACKGROUND AND PURPOSE: Since the approval of intravenous tissue plasminogen activator for acute ischemic stroke, great interest has been generated in cerebral fibrinolysis. Our purpose was to assess long-term outcome and hemorrhagic risk in patients with anterior circulation ischemic stroke treated with intraarterial urokinase. METHODS: Twenty-six patients were treated within 6 hours of ictus; of these, 21 were followed up for an average of 23 months. Angiographic reperfusion was classified according to thrombolysis in myocardial infarction (TIMI) grades. The Rankin Scale (RS) and the modified Barthel Index (mod BI) were used as outcome measures (good outcome: RS = 0-2, mod BI = 16-20; poor outcome: RS = 3-5, mod BI < or = 15). RESULTS: Ten of the 21 patients (average age, 48 years) had a good outcome; three (average age, 71 years) had a poor outcome; eight patients (average age, 78 years) died. Partial/complete (successful) recanalization was observed in 11 of 26 patients and minimal or no (unsuccessful) recanalization in 15. Recanalization favored a better outcome: nine of 21 had successful recanalization, with a good outcome in seven; 12 of 21 had unsuccessful reperfusion, with poor outcome/death in nine. Poor outcome was noted in five patients with internal carotid artery (ICA) bifurcation occlusions, four of whom had unsuccessful recanalization and poor outcome or death. Hemorrhage occurred in 10 of the 26 patients, with clinical deterioration in three. The average dose of urokinase was higher in the hemorrhage group, and mortality was higher in patients who hemorrhaged. CONCLUSION: Intraarterial thrombolysis is feasible in the setting of acute stroke. Successful reperfusion is associated with a better outcome, and the prevalence of hemorrhage does not exceed that which occurs in the natural history of embolic stroke. Poor outcome or death is associated with nonrecanalization, older age, hemorrhage, and ICA bifurcation occlusions.     

Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis

Introduction: Magnetic resonance imaging (MRI) may help identify acute stroke patients with a higher potential benefit from thrombolytic therapy. The aim of our study was to assess the correlation between initial cerebral infarct (CI) volume (quantified on diffusion-weighted MRI) and the resulting clinical outcome in acute stroke patients with middle cerebral artery (MCA) (M_1–2 segment) occlusion detected on MRI angiography treated by intravenous/intraarterial thrombolysis.Methods: Initial infarct volume (V_DWI-I ) was retrospectively compared with neurological deficit evaluated using the NIH stroke scale on admission and 24 h later, and with the 90-day clinical outcome assessed using the modified Rankin scale in a series of 25 consecutive CI patients. The relationship between infarct volume and neurological deficit severity was assessed and, following the establishment of the maximum V_DWI-I still associated with a good clinical outcome, the patients were divided into two groups (V_DWI-I ≤70 ml and >70 ml).Results: V_DWI-I ranged from 0.7 to 321 ml. The 24-h clinical outcome improved significantly (P=0.0001) in 87% of patients with a V_DWI-I ≤70 ml (group 1) and deteriorated significantly (P=0.0018) in all patients with a V_DWI-I >70 ml (group 2). The 90-day mortality was 0% in group 1 and 71.5% in group 2. The 90-day clinical outcome was significantly better in group 1 than in group 2 (P=0.026).Conclusion: Clinical outcome could be predicted from initial infarct volume quantified by MRI-DWI in acute CI patients with MCA occlusion treated by intravenous/intraarterial thrombolysis. Patients with a V_DWI-I ≤70 ml had a significantly better outcome.This paper was presented in part as a lecture at the 9th Congress of the European Federation of Neurological Societies Athens, Greece, 17–20 September 2005.     

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.     

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。     

Predictors of clinical outcome in patients receiving local intra-arterial thrombolysis without subsequent symptomatic intracranial hemorrhage against acute middle cerebral artery occlusion

BACKGROUND AND PURPOSE: The factors that predict favorable outcome after local intra-arterial thrombolysis (LIT) remain unknown. We aimed to clarify these factors in patients with middle cerebral artery occlusion treated by LIT. METHODS: We performed LIT in 26 consecutive patients who had middle cerebral artery occlusion with a modified Rankin scale (mRS) score or=3). RESULTS: The duration from symptom onset to hospital admission was 0.96 +/- 0.87 (mean +/- SD) hour and from onset of stroke to LIT was 3.78 +/- 1.17 hours. No patients developed symptomatic intracerebral hemorrhage or died. Thirteen patients achieved good outcomes. No significant differences existed between the two groups in baseline National Institutes of Health Stroke Scale (NIHSS) scores, time from stroke onset to LIT, blood pressure, early CT signs, or subsequent hemorrhagic transformation shown by CT. However, univariate analysis showed that patients with good outcomes were younger, more often had absence of hypertension history, had better collaterals shown by angiography, and had better recanalization rates than those with poor outcomes. NIHSS scores after LIT were lower in patients with good outcomes than in patients with poor outcomes. Logistic regression analysis indicated improvement of the NIHSS scores by >or=2 immediately after LIT was independently associated with good outcome. CONCLUSION: Improvement of the NIHSS score by >or=2 immediately after LIT is a useful predictor of patient outcome at discharge.     

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     

Local intraarterial urokinase thrombolysis of acute ischemic stroke with or without intravenous abciximab: a pilot study

PURPOSE: One of the most important prognostic factors in the thrombolytic treatment of acute ischemic stroke is the time to recanalization. To shorten the recanalization time, an antiplatelet agent, abciximab (platelet glycoprotein receptor IIb/IIIa antagonist), was administered intravenously before the initiation of local intraarterial urokinase thrombolysis. The purpose of this study was to evaluate the effectiveness and safety of this combined therapy. MATERIALS AND METHODS: A total of 26 patients with acute ischemic stroke (National Institutes of Health Stroke Scale score >10) were enrolled in this study. In the earlier phase of this study, conventional local intraarterial urokinase thrombolysis was performed in 16 patients (urokinase group). In the later phase, combined use of intravenous abciximab and local intraarterial urokinase thrombolysis was performed in 10 patients (urokinase + abciximab group). Recanalization rate (Thrombolysis in Myocardial Infarction grade >or=2), total amount of urokinase used, incidence of symptomatic hemorrhage, and better functional outcome rate (modified Rankin scale 相似文献   

Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke

BACKGROUND AND PURPOSE: Acute vertebrobasilar ischemic stroke is often associated with high morbidity and mortality with limited therapeutic options. Endovascular treatment with thrombolysis has offered some hope for affected patients; however, overall outcomes have been less than satisfactory. In this report, we present the results of our approach in six consecutive cases of acute vertebrobasilar ischemic stroke by combined proximal vessel stent placement and thrombolysis. METHODS: Six consecutive cases were retrospectively reviewed for the clinical outcome of patients presenting to our institution with acute posterior circulation stroke who underwent cerebral revascularization including proximal arterial stent placement by using balloon-expandable coronary stents and intraarterial thrombolysis. All of these patients were initially evaluated by stroke team neurologists and imaged with MR, including diffusion-weighted imaging documenting acute posterior circulation stroke. MR angiography of the circle of Willis was also obtained. Short-term follow-up was conducted to assess National Institutes of Health stroke scores (NIHSS) and modified Rankin scores. RESULTS: In these six cases, a combined approach of proximal arterial stent placement (five cases of vertebral artery origin and one case of carotid and subclavian stent placement plus vertebral artery revascularization) and thrombolysis was performed at variable times after stroke onset (range, 30 hours to 5 days). Four of the six patients had good basilar artery recanalization (Thrombolysis in Myocardial Infarction [TIMI] grade 0-1 before tissue plasminogen activator thrombolysis and TIMI grade 2 after procedure). Four of six patients had excellent immediate recovery and were discharged to an acute rehabilitation unit or their homes with improved neurologic symptoms and functional status. Two patients died: one patient presented with coma at outset with an NIHSS of 38, and the other patient probably had reocclusion of the basilar artery within 24 hours despite initial postprocedural improvement. CONCLUSION: We demonstrate that, in the setting of acute stroke, stent placement in combination with revascularization and thrombolysis is practical and allows quick access to a clot and simultaneously increases perfusion through collaterals during the thrombolytic process. In particular, basilar thrombolysis may be facilitated by proximal vertebral stent placement as concomitant atheromatous vertebrobasilar stenosis is common.     

Brain single-photon emission CT studies using 99mTc-HMPAO and 99mTc-ECD early after recanalization by local intraarterial thrombolysis in patients with acute embolic middle cerebral artery occlusion

BACKGROUND AND PURPOSE: The brain distribution of 9mTc-hexamethylpropyleneamine oxime (HMPAO) correlates with regional brain perfusion, whereas 99mTc-ethyl cysteinate dimer (ECD) reflects not only perfusion but also the metabolic status of brain tissue. We compared 99mTc-ECD single-photon emission CT (SPECT) with 99mTc-HMPAO SPECT early after recanalization by local intraarterial thrombolysis (LIT) in patients with acute embolic middle cerebral artery occlusion. We also assessed the predictive value of 99mTc-HMPAO and 99mTc-ECD SPECT for the development of ischemic brain damage. METHODS: 99mTc-HMPAO and consecutive 99mTc-ECD SPECT studies were performed in 15 patients within 3 hours of LIT. The two SPECT studies were obtained independently using a subtraction technique. SPECT evaluation was performed using semiquantitative region-of-interest analysis. Noninfarction, infarction, and hemorrhage were identified by follow-up CT or MR imaging. RESULTS: Forty-five lesions were identified (21 noninfarctions, 19 infarctions, and five hemorrhages). Regardless of 99mTc-HMPAO SPECT findings, lesions showing isoactivity (count rate densities of 0.9 to 1.1 as compared with the contralateral side) on 99mTc-ECD SPECT were salvaged. Lesions with hypoactivity (values < 0.9) on 99mTc-ECD SPECT developed irreversible brain damage. Hemorrhage appeared in lesions with both hyperactivity (values > 1.1) on 99mTc-HMPAO SPECT and hypoactivity on 99mTc-ECD SPECT. CONCLUSION: The brain distribution of 99mTc-ECD in a reperfused area identified by 99mTc-HMPAO SPECT early after recanalization of acute ischemic stroke is dependent on cerebral tissue viability. By combining 99mTc-ECD and 99mTc-HMPAO SPECT, performed within the first few hours of LIT, it is possible to identify patients at risk for hemorrhagic transformation reliably.     

rt-PA动脉内溶栓治疗急性脑梗死的临床研究

目的观察重组组织型纤溶酶原激活剂(rt-PA)动脉内溶栓(IAT)治疗急性脑梗死的疗效及并发症,分析预后相关因素。方法对12例发病后20h内的急性缺血性脑梗死患者行IAT治疗。血管再通程度根据“急性心肌梗死溶栓标准”(TIMI)分类。临床结果评价在溶栓后20d进行,根据改良的Rank分数(MRS)分为良好(MRS0～3)、不良(MRS4～6)两类。结果溶栓前1例为TIMI1,11例为TIMI0。溶栓后9例闭塞血管部分／完全再通,3例未再通。8例患者结果良好;4例不良结果;其中2例死亡。发生症状性脑出血1例,经治疗恢复良好。结论rt-PA用于急性脑梗死动脉溶栓,是安全可行的。     

影响急性缺血性脑卒中血管内治疗预后的相关因素分析

随着多项大型临床试验研究结果发布,血管内治疗(或联合静脉溶栓)被推荐为颅内大血管闭塞所致急性缺血性脑卒中患者首选治疗措施.然而,血管内再通治疗预后受到一系列因素影响.该文就影响血管内治疗预后的可能因素作一综述.     

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。