急性椎基底动脉闭塞的介入治疗

Interventional therapy for acute vertebrobasilar arterial occlusions

目的探讨急性椎基底动脉闭塞动脉内溶栓治疗,溶栓后血管狭窄的处理问题。方法收集我院2001年1月至2006年7月急性椎基底动脉闭塞患者67例。全脑血管造影后,责任动脉内泵入尿激酶,复查造影,溶栓后动脉残余重度狭窄者置入支架。结果溶栓后血管完全再通17例(25.4%),血管部分再通41例(61.2%),血管未通9例(13.4%)。临床症状恢复良好19例,轻度伤残23例,重度伤残8例,死亡17例。结论急性椎基底动脉闭塞溶栓治疗是有效的,时间窗应强调个体化,溶栓后血管残余狭窄可行支架置入术。

Objective To evaluate the effect of intra-arterial thrombolysis and stenting of residual stenosis for acute vertebrobasilar arterial occlusions. Methods From January 2001 to July 2007, 67 patients with acute vertebrobasilar arterial occlusion were selected. After 4-vessel angiography, the confirmed occlusion arteris were pumped with urokinase through catheterization to submerge the thrombi, and the residual stenosis after thrombolysis were treated with stenting. Results Complete recanalization was achieved in 17 （25.37%）, partial recanalization in 41 （61.19%）,and no recanalization in 9（ 13.43% ）. As regard to clinical prognosis, 19 had satisfactory clinical outcome, 23 and 8 showed mild and severe neurological disabilities, respectively. Death occurred in 17 cases. Conclusions Intra-arterial thrombolysis is safe and effective for acute vertebrobasilar Occlusions necessarily to have individualized therapeutic window and stenting ought to be followed for the residual stenoses. （J Intervent Radiol, 2007, 16： 348-350）