机械碎栓联合动脉内溶栓治疗急性脑梗死临床分析

Mechanical thrombectomy combined with artery thrombolysis in treating acute cerebral infarctio

目的观察机械碎栓联合动脉溶栓治疗急性脑梗死的临床疗效。方法选择21例急性脑梗死患者，发病到溶栓时间为6h，在数字血管减影机下进行全脑血管造影，找出责任闭塞血管，应用小球囊或支架（soltaire）进行血栓碎裂，或取栓后对残余血栓应用微导管进行动脉内溶栓；术后应用美国国立卫生院卒中量表（NIHSS）评分，2个月后应用牛津残障量表（OHS）进行预后评价。结果21例患右经过碎栓、溶栓治疗后有17例闭塞血管完全再通，4例未通。术后颅内出血1例，大面积脑梗死2例，但术后2个月应用OHS进行预后评价，其临床症状预后良好占76．19％。且术后NIHSS评分较术前明显下降。结论机械碎栓联合动脉溶栓是治疗急性脑梗死的一种安全、有效且可行的方法。

Objective To observe the clinical effect of mechanical thrombectomy combined with artery thrombolysis in treating acute cerebral infarction. Methods The period from the morbidity to thrombolysis was 6 hours for 21 patients with acute cerebral infarction; overall cerebral angiography was performed under the digital vessel subtraction machine; thrombus were crashed or fetched out through small saceulus or support after the responsible blocking vessel was found; then artery thrombolysis was performed on residual thrombus by means of micro conduit. The NIHSS assessment was performed after the operation, and the OHS was performed to evaluate the prognosis after three months. Results Among the 21 patients who achieve thrombectomy or thrombolysis treatment, 17 patients has full recanalization in blocking vessel; 4 patient has no reeanalization in blocking vessel; After the operation： 1 patient has intraeranial hemorrhage, 2 patients have massive cerebral infarction. However, three months after the operation, the good prognosis of clinical symptoms accounts for 76. 19% in the OHS assessment. Furthermore, the mark of NIHSS after operation decreases obviously compared with that before operation. Conclusions The combination of mechanical thrombectomy with artery thrombolysis is a safe, effective and feasible method to treat acute cerebral infarction.