急诊选择性动脉溶栓治疗急性脑梗死的临床分析

Analysis of therapeutic time window and effect in acuter cerebral infarction treated with superselective intra-arterial thrombolytic therapy

目的:评估急诊选择性动脉内溶栓(intra-arterial thrombolvsis,IAT)治疗急性缺血性脑梗死的治疗效果,探讨影响治疗时间窗和疗效的因素。方法:14例急性脑梗死患者均在CT检查、MRI+MRA及血管造影基础上接受超选择性动脉溶栓治疗,其中在6h以内溶栓11例,6～13h溶栓3例。统计各患者的侧支循环、TIMI分级及NIHSS评分情况。结果:脑血管造影发现8例患者存在较好侧支循环;溶栓后患者血管再通率为64.3%(9/14),TIMI分级达2～3级;9例成功再通患者中,7例(77.8%)神经功能显著恢复,1例再次大面积梗死;5例未再通患者中,3例临床症状改善不明显,死亡1例,仅1例(20%)神经功能恢复良好。14例患者中出现症状性颅内出血1例。结论:急诊动脉溶栓有效且安全可行,可根据MRI+MRA检查后的评价适当放宽溶栓的时间窗。溶栓前侧支循环、是否再通与预后密切相关。

Objective： To analyze the beginning time of treatment and the therapeutic effect of superselective intra - arterial thrombolysis in acute cerebral infarction. Methods： 14 patients with acute ischemic stroke examined by CT,MRI ＋ MRA and DSA were received superselective intra - arterial thrombolytic therapy, of them, the thrombolytic therapy was done within 6h in 11 cases and 6 - 13h in 3 cases after onset of stroke. The collateral circulatian, recanalization rate and clinical prognosis were statisticed after therapy. Results： Collateral circulation was found in 8 cases. The rate of complete / partial recanalization just after infusion was 64.3 % （9/14）. 9 cases＇ TIMI improved from 0 - 1 to 2 - 3 ,of them,7 cases （77.8%） had improved NIHSS; In the other 5 patients,which were not recanalizated,only 1 case （20%） had improved NIHSS,1 case died,3 cases had the same NIHSS after IAT. ICH was observed in 1 case. Conclusion：IAT is feasible and safe in the setting of acute stroke,the therapeutic time window is closely related to a lot of factors, it is not overall to be limited within 6 hours, MRI ＋ MRA PWI and DWI mismatch might be a selective standard for the beginning time of treatment. Collateral circulation, recanalization were significantly associated with good clinical outcome.