超选择性动脉内接触性溶栓治疗视网膜中央动脉血栓20例

目的探讨视网膜中央动脉(central retinal artery,CRA)血栓的血管内介入治疗,结合文献讨论动脉内接触性溶栓的可行性、有效性和操作方法。方法从1997年1月至2002年7月经超选择性动脉内接触性溶栓治疗CRA血栓形成20例,男14例,女6例,年龄19-71岁,平均46岁。起病距发病的时间为16 h至28 d,平均9 d。尿激酶用微量泵以1万U·ml-1·min-1持续泵入,总量为18~100万U。在泵入尿激酶的过程中,通过导引管造影,了解闭塞血管再通情况。结果经过治疗,即刻显效5例(25％),有效8例(40％),无效7例,总有效率为65％。1例术中发生大脑中动脉血栓,出现偏瘫、失语并发症,经即刻溶栓治疗康复。结论超选择性动脉内接触性溶栓,可使血栓局部迅速达到较高的血药浓度,疗效好,见效快,总药量小,并发症少,是治疗CRA血栓的有效方法。

Treatment of central retinal artery thrombus with superselective local intra-arterial fibrinolysis:a report of 20 cases

jective To investigate the treatment of endovascular intervene therapy in central retinal artery (CRA) thrombus, by combining with the references as to evaluating the possibility, the effectiveness, and the technology of local intra-arterial fibrinolysis. Methods From January 1997 to July 2002, superselective local intra-arterial fibrinolysis were performed in 20 patients, including male 14, female 6,with an age range of 19 to 71 years old, averaging 46 years. The duration from onset of symptoms to fibrinolysis were 16 hours -28 days,with a mean time of 9 days. First,the patients were given an immediate cerebral angiography to localize the lesion sites. Then microcatheters were navigated to the lesions, and urokinase was administered locally through the microcatheters by the pump at a rate of 10 000 unit . ml-1. min-1.The total dosage of UK was 180 000 to 1 million units. The average dosage was 700 000 units. Angiographys were performed repeatedly several times during the infusion of UK as to identifying whether the occluding vessels were recanalized or not. Results After treatment, there appeared an instant effectiveness in 5 cases (25% ) .effective in 8 (40% ), and uneffective in 7 (35% ) , with total effectiveness of 65% , Paralysis, dysphasia occurred in one patient who recovered after fibrinolysis. Conclusion Superselective local intra-arterial fibrinolysis should be an effective treatment of CRA thrombus, resulting in high concentration of medicine to location of thrombus, good effectiveness, less doses, and less complications. The efficiency of this modality might be more improved by the accompanying accumulation of experiences, exploitation of the new type of medicine and application of the neural protection means.