房颤脑栓塞患者的动脉溶栓治疗(12例报告)

Intra-arterial thrombolysis for acute cerebral arterial occlusion in patients with atrial fibrillation: report of 12 cases

目的探讨房颤脑栓塞患者动脉溶栓的方法及效果。方法 12例急性房颤脑栓塞患者经头颅弥散加权成像(DWI)证实有急性缺血性病变,采用动脉机械碎栓加尿激酶溶栓治疗。并对治疗时间、再通率、出血并发症进行观察,患者治疗30 d后采用美国国立卫生院神经功能缺损评分(NIHSS)进行预后评估。结果 10例患者血管获得再通,2例未能再通,再通患者中有1例出现出血转化。所有血管再通患者30 d后NIHSS明显好于未再通患者。结论溶栓治疗时间窗内的房颤脑栓塞患者进行动脉溶栓治疗是安全有效的。

Objective To discuss intra-arterial（IA） thrombolysis for acute cerebral arterial occlusion in patients with atrial fibrillation.Methods A total of 12 cases with atrial fibrillation were diagnosed as acute cerebral arterial occlusion by diffusion-weighted image.All patients were treated with combined IA urokinase and aggressive mechanical clot disruption（AMCD） in acute stage.Treatment time,recanalization rates,and symptomatic hemorrhage were analyzed.Clinical outcome measures were assessed by National Institutes of Health Stroke Scale（NIHSS） at 3 months after treatment.Results The recanalization was observed in 10 cases,including 1 case with hemorrhagic transformation.No recanalization occurred in 2 cases.Conclusion Combination therapy with IA urokinase and AMCD is safe and effective in patients with atrial fibrillation in acute stage.