小径球囊经皮腔内血管成形术对急性颅内动脉闭塞出血性转化的预防作用

Prevention Effects of Percutaneous Transluminal Angioplasty with Smaller Diameter Balloon on Hemorrhagic Transformation after Acute Occlusion of Intracranial Arteries

目的探讨以小径球囊经皮腔内血管成形术(PTA)为主或联用小剂量尿激酶(UK)对前循环颅内动脉急性闭塞部分再通术后出血性转化的预防作用。方法对38例前循环颅内动脉急性闭塞行超选择性介入治疗,其中16例采用常规UK+微导丝碎栓(对照组),22例采用小径球囊PTA或联用小剂量UK(PTA组)。比较两组再通后出血性转化发生率和预后。结果再通时间在对照组63.9±18.9min,PTA组18.3±8.1min,P<0.01;残留狭窄率<50%者在对照组75.0%(12/16),PTA组22.7%(5/22),P<0.01。7例发生出血性转化(对照组4例,PTA组3例),其中4例(对照组3例,PTA组1例)需外科处理,并遗有明显神经功能障碍。无一例因出血性转化而死亡。结论在治疗时间窗内,对颅内动脉急性闭塞采用小径球囊PTA为主的控制性部分再通术,对其出血性转化有较好的预防作用,并可明显提高部分再通率,缩短再通时间,为二期支架成形术打下良好的基础。

Objective To discuss the prevention effects of partial recanalization mainly by percutaneous transluminal angioplasty(PTA)with smaller diameter balloon or combining with low dose of Urokinase(UK)on hemorrhagic transformation after acute occlusion of anterior intracranial arteries.Methods We treated 38 cases with acute occlusion of anterior intracranial arteries by endovascular therapy,16 cases by routine UK with microcatheter and microwire(control group),22 cases by PTA with smaller diameter balloon or with low dose of UK(PTA group).We observed the frequency of recanalized hemorrhagic transformation and the prognosis in two groups.Results Recanalizing time was significantly shorter in PTA group than in control group(18.3±8.1 min vs.63.9±18.9 min,P<0.01).Residue stenosis rate of less than 50% were 75.0%(12/16)for control group,22.7%(5/22)for PTA group and there was significantly different between them(P<0.01).Total 7 of 38 patients suffered from hemorrhagic transformation,in which 4 cases occured in control group,3 cases in PTA group,and 4(3 in control group,1 in PTA group)of them needed surgery treatment with remaining severe dysfunction,but no one died because of hemorrhagic transformation.Conclusion Within therapy time window,partial recanalization mainly by PTA using smaller diameter balloon has active prophylactic effects on hemorrhagic transformation after acute occlusion of anterior intracranial arteries.It can largely elevate recanalizing rate and shorten recanalizing time,which is a good base for the following stent.