动脉内溶栓治疗急性缺血性脑卒中适应证探讨

目的根据脑血管造影结果的分类分型,初步探讨超选择动脉内溶栓治疗急性脑缺血性卒中的适应证。方法回顾1998年3月至2006年8月,急诊超选择动脉内溶栓治疗患者87例,男63例,女24例,年龄36-80岁,平均58岁;起病到接受治疗的时间为6小时以内;尿激酶以1-1.2万U/min持续泵入,总量为50-150万U,平均87.5万U。结果把脑血管造影的结果按闭塞程度分为完全闭塞、狭窄、未见异常三类。完全闭塞55例,狭窄组15例,未见异常组17例。闭塞组中,按责任血管和闭塞部位分,颈内动脉组18例,再通11例,溶通率为61.1%;大脑中动脉组20例,再通14例,溶通率为70%;椎-基底动脉型组12例,再通8例,溶通率为66.7%;双侧颈动脉系统多血管或伴椎-基底动脉系统血管明显病变者称为多发型,多发型5例中再通2例,溶通率为40%。神经功能评价：闭塞组35例再通患者中24例改善,占68.6%;闭塞未溶通者22例,5例改善,占22.7%;完全闭塞而由对侧代偿和或侧支循环形成者9例中1例恶化;狭窄组13例改善,2例无变化;未见异常组15例改善,1例无变化,1例恶化。结论超选择动脉内溶栓能够尽快使闭塞的血管再通,是治疗完全闭塞的急性缺血性脑卒中的一种有效方法。尤其适合心源性栓塞者、椎-基底动脉闭塞及颈内动脉闭塞而由对侧代偿和或侧支循环形成者。

Investigating of the indiction of selective intra-arterial thrombolysis for acute ischemic cerebral stroke

Object To investigate the indication of selective intra-arterial thrombolysis for acute ischemic cerebral stroke according to the occlusion type by the angiography results.Methods Analyzed retrospectively the 87 patients treated with selective intra-arterial thrombolysis.The patients were admitted from Mar 1998 to Aug 2006,including 63 men and 24 women aged from 36 to 80 years old with average of 58 years.The times from stroke onset to treatment beginning were all within 6 hours.Urokinase 10 000~12 000U/min was infused through the microcatheter controlled by micro pump,the total volume were 500 000~1 500 000U with average of 875 000U.Results The results of angiography were divided into three groups: complete occlusion,stenosis and no abnormal findings and there were 55 cases,15 cases and 17 cases respectively.T he occlusion group were further divided into different types: intracarotid cerebral artery(ICA) occlusion type,middle cerebral artery(MCA) occlusion type and veterbro-basilar artery(BA) occlusion type and multiple occlusion type(multiple vessels of bilateral ICA or BA involved).ICA occlusion 18 cases with 11 recanalization and the recanalization rate was 61.1%.MCA occlusion 20 cases with 14 recanalization and the recanalization rate was 70%.BA occlusion 12 cases with 8 recanalization and the recanalization rate was 66.7%.Multiple occlusion 5 cases with 2 recanalization and the recanalization rate was 40%.The neurofunction evaluation: In 35 recanalization cases of the occlusion group,24 improved with the improvement rate of 68.6%.In the 22 no recanalization cases of the occlusion group,5 improved with the improvement rate of 22.7%.In the stenosis group,13 improved and 2 in the no abnormal finding group,15 improved,1 deteriarated and 1 remained no change.Conclusion Selective intra-arterial thrombolysis is a effective method for for acute oclusive cerebral stroke due to recanalizing the occlusive brain blood vessles timely.Especially for the cardiac embolus genetic cerebral infarction,veterbral-basilar artery occlusion and intracarotid artery occlusion with the bypass circuit complements.