血管内介入治疗21例急性椎-基底动脉血栓形成疗效分析

Curative effect analysis of endovascular intervention for the treatment of 21 cases of vertebrobasilar thrombosis

目的:探讨血管内介入治疗急性椎-基底动脉血栓形成(VBT)的临床疗效。方法:对21例急性VBT患者行动脉内尿激酶溶栓,血管再通后对残余狭窄>70%的患者采用球囊扩张或血管内支架成形术进行治疗,评价发病6个月后患者的格拉斯哥预后评分(GOS)评分。结果:尿激酶溶栓后血管完全再通9例(42.86%),部分再通7例(33.33%),无变化5例(23.81%),总溶通率达76.19%。2例左椎动脉闭塞患者溶栓后残余80%狭窄,采用微球囊扩张后痊愈;3例椎动脉和2例基底动脉重度狭窄患者溶栓后在血管狭窄>70%处放置支架,4例痊愈,1例死亡。6个月后,除4例死亡,3例重度残疾外,其余14例GOS评分均>3分。结论:动脉溶栓加球囊成形术或支架成形术是急性VBT安全有效的治疗方法。

Objective. To discuss the clinical curative effect of endovascular intervention for the treatment of acute vertebrobasilar thrombosis （VBT）. Methods： Intra-arterial thrombolytic therapy by urokinase was practised in 21 cases with acute VBT. After the vascular recanalization, the patients whose vascular remains stenosis surpass 70% received the therapy of balloon dilation or percutaeous transluminal stenting. Evaluate the GOS of the patient after 6 months. Results： After the intra-arterial thrombolytic therapy by urokinase, vascular complete recanalization was achieved in 9 cases （42. 86%）, part recanalization was achieved in 7 cases （33.33%）, invalid therapy was achieved in 5 cases （23.81%） and the total rate of the recanalization was 76.19 %. Two patient of left vertebral artery occlusion whose vascular remains stenosis was 80% after the thrombolytic therapy received micro balloon dilation and recovered completely. After the thrombolytic therapy, three patients of vertebral severe stenosis and two patients of basilarartery severe stenosis received stent implantation, so 4 cases recoverd and 1 died. In the 5 cases, the stents were implanted into the vessel where the vascular stenosis was above 70%. After 6 months, 4 patients died, 3 patients paralysed severely and the GOS of the other 14 patients were all above 3. Conclusion. Intra-arterial thrombolysis combined with balloon dilation or percutaeous transluminal stenting is an effective method for the treatment of acute VBT.