单中心动脉溶栓治疗急性缺血性卒中576例的疗效分析

Intra-arterial thrombolysis for 576 cases of acute ischemic stroke: a single center analysis

目的探讨动脉溶栓治疗急性缺血性卒中的安全性及有效性。方法回顾性分析首都医科大学宣武医院介入放射诊断治疗科2000年1月—2010年9月的病例资料,共对急性缺血性卒中进行动脉内溶栓576例,其中男416例,女160例,平均年龄(55±10)岁。对前、后循环病变的治疗时间窗分别为(5.1±1.8)、(9.1±2.2)h,尿激酶剂量分别为(82±21)、(104±15)万U。结果①颈内动脉系统闭塞389例,病例再通率为61.7%,辅助球囊扩张或支架置入68例,溶栓术后2周,改良Rankin量表评分(mRS)改善率为66.1%,症状性颅内出血率为13.3%;②椎-基底动脉系统闭塞101例,再通率为64.3%,辅助球囊扩张或支架置入30例,溶栓术后2周mRS改善率为43.6%,症状性颅内出血率为5.0%;③脑血管造影阴性86例,占总病例的14.9%。结论颅内外动脉闭塞经溶栓后,再通率、mRS改善率和症状性颅内出血率显示,动脉溶栓治疗急性缺血性卒中是一种较安全、有效的治疗方式。

Objective To investigate the safety and efficacy of intra-arterial thrombolysis in the treatment of acute ischemic stroke. Methods The clinical data of the patients in the Department of In- terventional Radiology, Xuanwu Hospital, Capital Medical University from January 2000 to September 2010 were analyzed retrospectively. A total of 576 patients with acute ischemic stroke were treated with intra-arterial thrombolysis, 160 patients were female and 416 were male, their mean age was 55 ± 10 years old. The therapeutic time windows of anterior and posterior circulation lesions were 5.1 ± 1.8 and 9. 1 ± 2. 2 h respectively, and the dosages of urokinase were 82 ± 21 and 104 ±15 U respectively. Results ①389 patients had internal carotid arterial occlusion, their recanalization rate was 61.7%, and 68 patients were conducted with laser-assisted balloon dilation or stent placement. The improvement rate of mRS was 66. 1% 2 weeks after thrombolysis, and the symptomatic intracranial hemorrhage rate was 13.3%. ②101 patients had vertebral-basilar arterial occlusion, the recanalization rate was 64. 3%. Thirty patients were conducted with laser-assisted balloon dilation or stent placement. The improved rate of mRS was 43.6% 2 weeks after thrombolysis, and the symptomatic intracranial hemorrhage rate was 5.0%. ③Cerebral angiography was negative in 86 patients, accounting for 14. 9% of all the cases. Conclusion After thrombolysis of extracranial and intracranial arterial occlusion, the rate of recanalization, the improved rate of mRS, and the rate of symptomatic intracranial hemorrhage showed that arterial thrombolysis in the treatment of acute ischemic stroke is a relatively safe and effective method of treatment.