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.

Analysis of Therapeutic Time Window and Effect in Acute Cerebral Infarction Treated with Intra-arterial Thrombolytic Therapy

Objective To investigate the relation between the therapeutic effect and time window in local intra-arterial thrombolysis for acute cerebral infarction.Materials and Methods 245 patients with acute ischemic cerebral stroke examined by CT and angiography were treated by intra-arterial thrombolysis.56 cases were treated by thrombolysis within 6 hours from onset of stroke,189 cases were treated by intra-arterial thrombolysis between 6 to 24 hours.The recanalization rate and clinical outcome for 90 days in two groups were evaluated.Results Angiography showed occlusion of the cerebral artery in 245 patients,among them,173 patients showed the occlusion in the internal carotid artery(ICA)system,72 patients in the vertebrobasilar artery(VBA)system,successful recanalization was achieved in 150 patients(113 patients in ICA and 37 patients in VBA).Followed up for 90 days,180 patients had a good outcome,65 had poor prognosis.12 patients were associated with intracranial hemorrhage.Good prognosis rate of 6h group and 6-24h group was 80.35%(45/56)and 71.43%(135/189)respectively,the recanalization rate of two groups was 66.07%(37/56)and 59.79%(113/189),the mean time of occluded artery recanalization was 67min and 73min respectively.Conclusion Successful recanalization of cerebral occlusive artery by using intra-arterial thrombolysis could improve clinical prognosis in patients with acute ischemic cerebral stroke.It is not enough to limited therapeutic time window within 6 hours,some cases with cerebral infarction after 6 hours of stroke onset can benefit from intra-arterial thrombolytic therapy.