局部动脉溶栓治疗急性颈内动脉系统脑梗死

Local intra-arterial thrombolysis in acute cerebral infarction of the anterior circulation

目的观察局部注射尿激酶动脉溶栓治疗急性颈内动脉系统脑梗死的疗效及并发症。方法对64例发病于6h内的急性颈内动脉系统脑梗死患者行动脉内超选择性尿激酶溶栓治疗。其中颈内动脉主干闭塞7例(10.9%),大脑中动脉主干及分支闭塞49例(76.6%),大脑前动脉闭塞8例(12.5%)。结果经溶解血栓治疗后完全再通37例(57.8%),部分再通15例(23.4%),未通12例(18.8%);溶解血栓治疗后3个月疗效良好的患者45例,疗效差19例;52例溶通患者中疗效良好42例(80.1%),12例未溶通患者中疗效良好3例(25.0%);溶栓后脑出血14例(21.9%)。结论局部动脉溶栓治疗能明显提高血管再通率,明显改善预后,是治疗急性脑梗死的一种有效和安全的方法。

Objective To observe the efficacy and complication of local intra-arterial thrombolysis（LIT） using urokinase in patients with acute cerebral infarction of the anterior circulation. Methods 64 patients with acute cerebral infarction of the anterior clrculation within 6h from onset were treated with intra-arterial thrombolysis using urokinase. The locations of occusion included 7 of internal carotid artery（ICA） ,49 of middle cerebral artery（MCA） and 8 of anterior cerebral artery（ACA） .Results Complete recanalization just after thrombolysis were observed in 37 of the 64 patients（57.8 % ）, partial recanallzafion in 15 of the 64 patients（23.4 % ）, no recanalization in 12 of the 64 patients（ 18.8% ） .The clinical outcome 3 months after thrombolysis was evaluated according to MRS score.45 patients were gocst outcome （ MRS score, ≤2） and 19 patients were poor outcome （ MRS score, ≥3 ）. 52 of the 64 patients（ 80.1% ） of complete/partial recanalization were good outcome, only 3 of the 12 patients （25.0 % ） of no recanalizaion were good outcome. Cerebral hemorrhages occured in 14 patients（21.9% ） after thrombolysis. Conclusion LIT using urokinase can apparently improve the rate of recanalization and clinical outcome.It is an effective and relatively safe therapy in treatment of acute cerebral infarction.