rt-PA动脉溶栓治疗急性脑梗死的疗效观察

Inter-arterial thrombolysis using rt-PA for acute cerebral ischemic stroke

目的分析动脉溶栓治疗急性脑梗死的安全性及疗效。方法对21例颈内动脉系统梗死患者(颈内动脉3例,大脑中动脉12例,大脑前动脉5例,豆纹动脉1例)进行rt-PA动脉溶栓治疗。治疗时间在发病后2～6h,观察术中血管再通及术后即刻、24h后分别行头颅CT或MRI扫描以明确有无颅内出血。术前及术后30d采用中国脑卒中神经功能缺损程度量表(chinese stroke scale)进行评估。结果21例患者动脉溶栓治疗中技术成功率100%。其中血管再通TMI分级2～3级16例,TMI分级0～1级5例。症状性脑出血3例,其中2例死亡。17例术后30d神经功能缺损评分减少>50%,2例<50%,死亡2例。TMI分级2～3级的血管再通患者生活状态明显优于TMI分级0～1级血管再通患者。结论急性脑梗死6h内动脉溶栓治疗比较合适,但也有并发脑出血的严重后果,开始溶栓时间越早越好。

Objective To evaluate the safety and efficacy of intra-arterial thrombolysis in patients with acute cerebral ischemic stroke. Methods Twenty-one patients with acute internal carotid circulation infraction （internal carotid 3, MCA 12, ACA 5, lenticulostriate in 1 ）were treated with intra-arterial thrombolysis of recombinant tissue plasminogen activator （rt-PA）which was performed within 2 - 6 hours of symptom onset. Recanalization was observed during the operation. Intracerebral hemorrhage （ICH）was monitored immediately and 24 h after the treatment by CT or MRI scanning. Chinese stroke scale was used to evaluate the recovery of neurological functions pre-operatively and 30 d after the treatment. Results All the 21 patients were 100% success in receiving intra-arterial thrombolysis technique and revealed 16 having the degree of recanalization of 2 to 3 grade as regards to TMI, 16 patients＇ degree of recanalization reached 2 to 3 grade according to TMI; 5 patients showed 1 to 2 grade. Symptomatic ICH was observed in 3 patients, with two dead. Arterial dissection was found in one patient. Thirty days after the operation, 17 patients＇ cerebral function reduced over 50 percent; 2 less than 50 percent; and 2 died. The patients achieved 2 to 3 grade of recanalization were obviously getting better than those achieving 0 to 1 grade. Conclusions It is adapt to have intra-arterial thrombolysis with six hours from onset ; but still have the danger of severe ICH. The treatment should be started as early as possible. （J Intervent Radiol, 2007, 16： 580-583）