动脉内接触性溶栓治疗急性椎基底动脉血栓的临床观察

目的:观察分析椎基底动脉系统急性脑梗死采用动脉内接触性溶栓治疗的安全性和疗效。方法:对入选符合溶栓条件的椎基底动脉系统急性脑梗死的患者,经全脑血管造影检查证实梗塞部位及责任血管后,行介入方法椎基底动脉内接触性溶栓。先用微导丝和微导管探查血栓,自血栓内穿过至血栓远端,以了解血栓的长度和部位,然后用微导丝在血栓近端捣碎,随后将微导管头端置于血栓近端通过微导管局部分次推注尿激酶,根据血栓溶解及血管再通情况控制尿激酶总量在150万U以内。术中适时检测凝血时间及纤维蛋白原。结果:自2005年～2008年共选择治疗12例病人,溶栓后血管再通10例(83.3%),未成功再通2例(16.7%),10例再通病人中8例疗效良好。溶栓后发现基础血管中重度狭窄3例。结论:急诊动脉溶栓是急性椎基底动脉栓塞和血栓形成有效治疗方法,可增加血管再通率,明显改善椎基底动脉缺血性卒中病人的预后。

Clinical Observation of Intra-arterial Thrombolysis in Acute Vertebrobasilar Artery Thrombosis

Objective:To observe and analyze the vertebrobasilar system cerebral infarction by arterial thrombolysis contact the safety and efficacy.Methods:The selected meet the conditions of thrombolysis in acute vertebrobasilar system cerebral infarction patients,by cerebral angiography confirmed infarct vessel position and responsibility after the interventional method of contact within the vertebrobasilar arterial thrombolysis.The first guide wire with a micro-probe and micro-catheter thrombosis,blood clots from the thrombus through to the remote to find the length and location of thrombus,and then use micro-guide wire broken in the proximal thrombus,then placed in micro-catheter tip thrombus Bureau of the proximal part of the second catheter through the micro-injection of urokinase,thrombolytic and recanalization under controlled conditions in the 1.5 million U of urokinase within the total.Timely detection of intraoperative clotting time and fibrinogen.Results: From 2005 to 2008 were selected for 12 patients,recanalization after thrombolysis,10 patients(83.3%),was not successful recanalization in 2 cases(16.7%),10 cases of recanalization,8 cases of patients well.The basis of the blood vessels after thrombolysis found 3 cases of severe stenosis.Conclusion:Emergency arterial thrombolysis for acute vertebrobasilar artery thrombosis embolism and effective treatment methods, increase the recanalization rate was significantly improved vertebrobasilar ischemic stroke prognosis.