急性大脑中动脉闭塞的血管内治疗

Endovascular Treatment of Acute Middle Cerebral Artery Occlusion

目的：探讨急性大脑中动脉闭塞血管内溶栓和支架置入术的可行性、安全性和应用价值。方法：回顾性分析21例急诊行血管内治疗的大脑中动脉闭塞患者资料，其中17例单纯采用局部超选择性动脉内溶栓，4例同时采用支架置入术。结果：溶栓后大脑中动脉心肌梗死溶栓疗法分级（TIMI）3级13例（包括4例同时行支架置入术的重度狭窄患者），TIMI2级7例，TIMI1级1例。住院期间因心肌梗死死亡1例，其余患者3个月随访改良gankin量表评分0分8例，1分6例，2分3例，3、4和5分各1例。结论：血管内治疗是治疗急性大脑中动脉闭塞的一种安全、有效的方法，支架置入术结合超选择性局部动脉内溶栓可有效减少开通血管的再次闭塞。

Objective： To investigate the feasibility, safety, and application value of endovascular thrombolysis and stenting in acute middle cerebral artery occlusion. Methods： The data of 21 patients with acute middle cerebral artery occlusion treated with emergency endovascular therapy were analyzed retrospectively. Seventeen of the patients were treated with the supperselective intra-arterial tbrombolysis alone, and at the same time, 4 patients were treated with stenting. Results： Thirteen patients （including 4 patients with severe stenosis treated with stenting） had tbrombolysis in myocardial infarction （TIMI） grade 3 flow in middle cerebral artery after tbrombolysis; 7 patients had TIMI grade 2 flow, and 1 patient had TIMI grade 1 flow. One patient died of myocardial infarction during hospitalization, The modified Rankin scale （MRS） scores during 3-momth follow-up were 0 in 8 patients, 1 in 6 patients, 2 in 3 patients, and 3, 4 and 5 in 1 patient each. Conclusions： Endovascular therapy is a safe and effective approach in the treatment of acute middle cerebral occlusion. Stenting combined with superselective intra-artery tbrombolysis may effectively reduce the reocclusion of recanalized arteries.