前循环大动脉闭塞所致的急性卒中后6～9小时动脉溶栓治疗27例分析

Treatment of anterior circulation large arterial occlusion caused acute stroke with intra-arterial thrombolysis:a report of 27 cases

目的探讨颈内动脉系统大动脉闭塞导致的急性缺血性卒中后6～9 h内动脉溶栓的治疗效果。方法回顾性分析27例前循环大动脉闭塞的急性缺血性卒中患者的资料,发病距接受溶栓治疗的时间为6～9 h,头部CT未显示脑出血和明确的梗死灶,全脑血管造影明确责任血管后,采用尿激酶进行选择性动脉溶栓,尿激酶以1.5万U/min持续泵入,总量为50～150万U。血流动力学评估采用前向血流评定(TICI)。结果在27例溶栓的前循环大动脉闭塞的患者中,颈内动脉闭塞的有10例,大脑中动脉主干闭塞的有15例,大脑前动脉主干闭塞的有2例。动脉粥样硬化性卒中20例,心源性卒中7例。溶栓治疗后,血管完全再通(TICI分级:3级)的为5例,部分再通(TICI分级:2级)的为15例,未再通(TICI分级:0～1级)的为7例,血管再通率为74.1%,总病死率为14.8%。20例动脉粥样硬化性卒中患者,溶栓治疗后血管再通率为90%,死亡率为0;7例心源性卒中患者,溶栓治疗后血管再通率为28.5%,死亡率为4/7。与溶栓治疗前相比,动脉粥样硬化性大动脉闭塞患者的NIHSS评分和修订Rankin量表评分降低,差异有统计学意义(P<0.05)。结论对前循环动脉粥样硬化性大动脉闭塞导致的急性缺血性卒中的患者,在头部CT未显示有明确梗死灶的前提下,6～9 h内选择动脉溶栓是较为有效的治疗方法。

Objective To investigate the efficacy of intra-arterial thrombolysis for treatment of large arterial oeelusion caused acute isehemic stroke in the internal carotid system within 6 to 9 hours after onset. Methods Twenty-seven patients of acute ischemie stroke caused by anterior circulation large arterial occlusion were reviewed. The time from the onset to receiving the thrombolytie treatment was 6 to 9 hours. After cerebral angiography confirmed the guilty vessels, the selective intra-arterial thrombolysis was performed with urokinase（ 15 000 U/min） pumped continuously, and the total amount of drug was 500 000 to 1 500 000 traits. The forwand blood flow （thmmbol）sis in cerebral infarction, TICI） was used to evaluate the dynamics of blood flow. Results Among the 27 patients with anterior circulation large arterial occlu- sion, 10 were internal earotid occlusion, 15 were middle cerebral artets, stem occlusion, and 2 were anterior cerebral artery stem occlusion. Twenty patients were eansed by atheroselerotie thrombosis, and 7 were due to eardioembolism. After thromholysls, 5 were eompletely reeanalized （TICI grade 3）, 15 were partially recanalized （ TIC1 grade 2 ） , mad 7 did not reeanalized（ TICI grade 0 to 1 ）. The reeanalizalion rate was 74.1% , and the mortality rate was 14.8%. The reeanalization rate in 20 patients with atherosclerosis was 90% , the mortality rate was 0 after the thrombolysis; the recanalization rate in 7 patients with eardioembolism was 28.5% after the thrombolvsis, and the mortality rate was 57.1%. The P, arthel index （BI） in patients with ather-osclerotic occlusion increased significantly compared to that before thronbolysis, and the nlodified Rankin scale （mRS） scores decreased significantly （P 〉0.05）. Conclusion In patients with anterior circulation large arterial atherosclerotic occlusion caused acute ischenfic stroke, and no definite brain infarction on CT scan was found,arterial thrombolvsis within 6 -9 hours after onset may be the best choice of treatment.