急性脑栓塞的选择性动脉溶栓治疗

Intra-arterial thrombolysis in acute embolic stroke

目的评价急性脑栓塞(AES)动脉溶栓疗法的有效性及安全性。方法应用尿激酶或rt-PA经股动脉选择性动脉溶栓(IAT)治疗AES患者21例,并选择同期未行溶栓治疗的AES患者42例作为对照组。比较两组间治疗后24hNIHSS评分、90d改良Rankin量表(mRS)评分、出血转化(HT)及病死率等。结果①IAT治疗后脑血管造影结果:血管总再通率为61.9%;大脑中动脉(MCA)、颈内动脉(ICA)及基底动脉(BA)再通率分别为83.3%、2/7和1/2。②治疗后24hNIHSS评分IAT组明显低于对照组(12.05±5.61比14.83±4.05,P<0.05);IAT组预后良好(mRS0～2分)比率显著高于对照组(66.7%比35.7%,P<0.05);③IAT组与对照组相比,HT发生率(28.6%比16.8%)、患者病死率(19.1%比16.7%)均无显著差异;两组均没有患者死于HT。结论IAT治疗AES可能具有较好的疗效,相对安全。

Objective To evaluate the efficacy and safety of intra-arterial thrombolysis in acute embolic stroke （AES）. Methods 21 patients with AES were undertaken urokinase or recombinated tissue plasminogen activator through percutaneous femoral intraarterial thrombolysis （IAT） as the treated group, and another 42 patients without thrombolytic treatment were assigned as the control group, which were matched to the baseline National Institutes of Health Stroke Scale （NIHSS） scores with selected gender and age. 24 h NIHSS scores, 90 d modified Rankin Scale （mRS） scores, incidences of hemorrhagic transformation （HT） and mortalities of the two groups were compared after the treatment. Results （1） The results of cerebral angiography showed that the total re-perfusion rate was 61.90%. The middle cerebral artery （MCA）, the internal carotid artery （ICA） and the basilar artery （BA） re-perfusion rates were 83.33%, 28.57% and 50.00%, respectively. （2） The NIHSS scores after 24 h were lower in the treated （IAT） group than those in the control group （12.05 ± 5.61 vs, 14.83 ± 4.05, P 〈 0.05）. A favorable outcome （mRS of 0 - 2） was more frequently observed in the IAT group （66.67%） than that in the control group （35.71% ,P 〈 0.05）. （3） There was no significant difference between the rates of HT （28.57% vs. 16.77%） and also the similar mortality rates （19.05% vs. 16.67%） not significant between the two groups. No patient died of HT in both two groups. Conclusion IAT may be an effective treatment for AES with comparative safety.