动脉内溶栓联合支架治疗基底动脉闭塞临床报道

The combined application of intra-arterial thrombolysis and endovascular stent-assisted angioplasty for the treatment of basilar artery occlusion

目的探讨溶栓后即刻置入支架的方法治疗急性椎基底动脉系统卒中溶栓术后血管重新闭塞的有效性和安全性。方法回顾性分析北京宣武医院2003年7月～2004年12月采用动脉内溶栓加支架置人治疗的7例脑卒中患者的临床资料.采用尿激酶超选择动脉溶栓,溶栓后对血管狭窄行支架成形术。结果7例溶栓后均再通。基底动脉尾段狭窄1例,主干狭窄4例,头段狭窄2例,动脉狭窄率平均为85%,即刻置人冠脉支架。置入支架后造影显示血管形态良好,残留狭窄率小于20%。术后复查点片状脑出血2例。术后症状好转或消失6例,围手术期死亡1例。结论超选择动脉溶栓联合支架治疗能够防止血管再闭塞及卒中复发,改善病人预后。

Objective To explore the effectiveness and safety of intracranial stenting performed immediately after intra-arterial thrombolysis to therapy the rate of vessel re-occlusion after thrombolysis for the treatment of acute stroke of vertebral-basilar artery system. Methods The clinical data of 7 cases, who received the combined application of intra-arterial thrombolysis and endovascular stent-assisted angioplasty for the treatment of their cerebral stroke during Jul., 2003 and Dec., 2004 in Beijing Xuanwu Hospital, were retrospectively analyzed. The 7 cases included 6 males and 1 female with age ranging from 41-74 years old and duration from the onset of symptoms to thrombolysis were 2 to 18 h. The intra-arterial superselective thrombolytic therapy with urokinase was applied for these cases and if severe stenosis was found, endovascular stent-assisted angioplasty was administered immediately after thrombolysis. Results Recanalizations were achieved in 7 cases. Stenoses were found in different segments of the basilar artery, including the caudal part in 1 case, main trunk in 4 cases and distal part in 2 cases; the artery stenosis rate was 85% on average and emergent coronary stents were implanted. The coronary angiogram after stent implantation indicated that the lesion vessels were smooth and the residual stenosis rate was less than 20%. Postoperative recheck found that two 2 cases had petechial hemorrhage of the brain. Postoperative symptoms of 6 cases were alleviated or disappeared and 1 case died. Conclusion The intra-arterial superselective thrombolytic therapy combined with endovascular stent-assisted angioplasty is effective for inhibiting basilar artery re-occlusion and stroke recurrence, which can thereby improve prognosis in patients.