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.

Combined intraaterial and intravenous thrombolysis using r-tPA for acute cerebral ischemic stroke

Objective To evaluate the method and clinical outcome of combined intraarterial and intravenous thrombolysis using r-tPA for acute ischemic stroke. Methods Fifteen patients with acute ischemic stroke were all undergone CT, MR and DSA before the procedure including M1 segment occlusion in 4 patients, M2 in 2, both M3 and M4 in 2, both A1 and A2 in 1, P1 in 1, internal carotid in 2, lenticulostriate artery in 1,and perforating branches in 2 with confirmation of it by DSA preoperatively. Local intra-arterial infusion of drug and mechanical distruption of clot were performed within 3-7 hours of symptom onset, in combination with intravenous thrombolysis using r-tPA pre- / post-operation. Clinical outcome and radiological findings were evaluated. Results In all patients, technical success was 100% with effective recanalization of the occluded arteries under DSA but with patchy blood oozing in 2 and ectopic cerebral infarction in 1 revealed by CT. The function of limbs immediately improved in 6 cases after the procedure. Followed up for 3 months, 6 patients had excellent outcome, 7 with good outcome and 2 of poor outcome; and maintaining complete life activity in 13 with effective rate of 87% (13/15), with portial life activity in 1 and lost in 1 but no mortality. Conclusions Combined intraarterial and intravenous thrombolysis with low-dose r-tPA is a safe and effective measure for acute ischemic stroke. Effective combination of local intra-arterial infusion of drug with mechanical distruption of clot together with a synthetic analysis of pre-operation imaging of CT, MR and DSA will facilitate intra-arterial thrombolysis.