动脉溶栓联合血管成形术治疗急性重症缺血性卒中患者疗效分析

目的探讨动脉溶栓联合血管成形术治疗急性重症缺血性卒中的临床疗效及安全性。方法 2009年9月—2013年4月,首都医科大学宣武医院对单纯动脉溶栓后(尿激酶)再通不良的16例重症急性缺血性卒中美国国立卫生院卒中量表评分中位数(NIHSS)18(14～21)分;改良Rankin评分(mRS)中位数4(3～5)分]患者行血管成形术治疗。对其中6例行球囊扩张术,3例行支架置入术,7例行球囊扩张联合支架置入术。结果①16例患者术前血流灌注(TIMI)分级0级14例(87.5%),1级2例(12.5%)。术后14例血管再通,总再通率为87.5%。其中11例(68.8%)完全再通,3例(12.5%)部分再通。行球囊扩张联合支架置入术的7例,均为完全再通;单纯支架置入术的3例,完全再通2例,部分再通1例;单纯球囊扩张术的6例,完全再通2例,部分再通2例,未再通(TIMI分级由0级变为1级)2例。②术后2例(12.5%)死亡,1例于术后第5天死于小脑及脑干出血,另1例于术后第6天死于蛛网膜下腔出血。③生存的14例患者,术后2周NIHSS评分和mRS评分均较术前明显改善;术后3个月,NIHSS和mRS评分较术后2周进一步改善。差异均有统计学意义,P<0.01或P<0.05。采用超声随访14例患者,随访时间中位数19.5(3～46)个月,仅行球囊扩张术后的1例患者出现再狭窄。结论单纯动脉溶栓后再通不良的重症急性缺血性卒中,联合血管成形术可能会提高血管再通率,改善临床预后。其中联合支架置入术可能较单纯联合球囊扩张术具有更高的再通率。

Efficacy analysis of intraarterial thrombolysis in combination with angioplasty in the treatment of patients with severe acute ischemic stroke

Objective To investigate the clinical efficacy and safety of intraarterial thrombolysis in combination with angioplasty in the treatment of severe ischemic stroke. Methods A total of 16 patients with severe acute ischemic stroke （the National Institutes of Health Stroke Scale NIHSS] score 18 14 to 21 ] ）, the modifed Rankin scale mRS] score 4 3 to 5 ] ） who had poor recanalization after arterial thrombolysis （urokinase） alone underwent angioplasty in Beijing Xuanwu Hospital, Capital Medical Uni- versity from September 2009 to April 2023. Six of them performed balloon angioplasty, 3 performed stenting alone, and 7 performed balloon dilatation plus stenting. Results （~14 （ 87.5% ） of the 16 patients had preoperative blood flow perfusion （TIMI） grade 0 and 2 （ 12.5% ） had grade 1. Fourteen patients had re- canalization after procedure. The total recanalization rate was 87.5% （14/16） , 11 （68.8%） of them had complete recanalization and 3 （ 12.5% ） had partial recanalization. Seven patients performed balloon dila- tation plus stenting, they were all had complete recanalization; 3 had stenting alone, 2 had complete reca-nalization, 1 had partial recanalization; 6 had balloon angioplasty alone, 2 had complete recanalization, 2 had partial recanalization, and 2 did not recanalized （TIMI grade from 0 to 1 ）. （~）2 patients （ 12.5% ） died after procedure, 1 died of cerebellum and brain stem hemon＇hage at day 5 after procedure, and another died of subarachnoid hemorrhage at day 6 after procedure. ~）14 patients survived, their NIHSS and mRS scores at 2 weeks after procedure were improved significantly compared to before procedure. At 3 months after procedure, the NIHSS and mRS scores were further improved than that at 2 weeks after procedure. The differences were statistically significant （P 〈 0.01 or P 〈 0.05 ）. Fourteen patients were followed up for 19.5 （3 to 46） months using ultrasonography, after balloon dilatation, only 1 patient had restenosis. Conclusion In patients with severe acute ischemic stroke and poor recanalization after intraarterial thrombolysis alone, it combination with angioplasty may increase the recanalization rate and improve clinical outcomes. In combination with stenting may have higher recanalization rate compared to balloon angioplasty alone.