动脉内接触性溶栓治疗急性缺血性脑卒中

目的探讨急性缺血性脑卒中动脉内接触性溶栓治疗的安全性和有效性。方法对178例急性缺血性脑卒中病人在起病后2～24h进行尿激酶超选择性动脉内接触性溶栓,尿激酶用量50～130万U(平均85万U)。结果颈内动脉系统血管闭塞117例,椎-基底动脉系统闭塞30例,脑血管造影未见明显异常31例。闭塞的颈内动脉再通14例,大脑中动脉再通29例,大脑中动脉分支再通30例,椎-基底动脉系统再通20例。11例因血管狭窄明显,溶栓后给予球囊扩张、支架置入术。临床症状完全恢复正常或明显好转108例,并发脑出血6例,消化道出血15例。结论超选动脉内接触性溶栓可使血栓局部迅速达到较高的血药浓度,疗效好,见效快,用药总量小,并发症少。

Intra-arterial thrombolysis for acute ischemic stroke

Objective To evaluate the safety and efficacy of intra-arterial thrombolysis for acute ischemic stroke. Methods 178 patients were studied. The duration from onset to thrombolysis was from 2 to 24 hours. Urokinase was administered locally through the microcatheter by the pump at the rate of 10 000-12 000 unit/min. The total dosage of UK was 500 000 to 1.3 million units, and the average dosage was 850,000 units. Results 117 occlusions were found in ICA, and 30 in vertebral-basilar artery. No obvious abnormality was identified in 31 cases. Recanalization of ICA territory was achieved in 14 cases, MCA in 29, MCA branches in 30, and vertebral-basilar artery in 20 cases. 11 patients received angioplasty with balloon or stents for severe stenosis of the vessels. 108 cases obtained good results. However, complications occurred, including 6 cases of brain hemorrhage and 15 cases of hemorrhage of upper digestive tract. Conclusion Superselective local intra-arterial thrombolysis for acute ischemic stroke is a valuable therapy with the advantage of good effectiveness, lower dose and fewer complications.