缺血性脑卒中超早期选择性动脉溶栓治疗

Super-early selective intraarterial thrombolysis in acute ischemic stroke

目的 评价超早期选择性脑动脉溶栓疗法 (SIT)对急性缺血性脑卒中的疗效及安全性。方法 32例急性缺血性脑卒中患者起病至溶栓时间介于 1～ 6小时。尿激酶用量 87 6 6± 17 6 3万单位。溶栓前先用微导丝通过血栓到达血栓远端 ,导丝撤出后 ,将导管置于靶血管闭塞点或患侧颈内动脉进行溶栓治疗。结果 颈内动脉闭塞 12例 ,3例完全再通 ,2例部分再通。大脑中动脉闭塞 2 0例 ,19例完全再通。治疗后 3个月神经功能恢复率为 81% (2 6 /32 )。 4例合并无症状性脑出血均痊愈。血管再闭塞 1例 (经重复造影证实 )。结论 超早期SIT治疗可使闭塞血管再通。溶栓后并发无症状性脑出血患者临床可恢复正常。SIT是目前治疗急性缺血性脑卒中有效的治疗手段。

Objective To evaluate the therapeutic effect and safety of the selecti intraarterial thrombolysis(SIT) in acute ischemic stroke.Methods 32 acute ischemic stroke cases had been treated. The interval from onset of stroke to thrombolysis was 1～6 hour. The urokinase of 876600±176300U was used. Making the microguidewire past through and reach to the distal of the embolus, removing the guidewire then the thrombolytic therapy was performed at the site of occlusion or in the internal carotid artery.Results Among the 12 cases with occluded internal carotid artery. 3 cases were completely recanalized. 2 cases were partially recanalized. Among the other 20 cases with occlusion of middle cerebral artery, 19 cases were completely recanalized. Three month after treatment the recovery rate of neurologic deficits was 81%(26/32). 4 cases with symptom free brain hemorrhage were cured. ICA reocclusion were found in one case that was defined by repeat examination.Conclusions Super early SIT can make the occluded vessel recanalization in most cases. The thrombolysis related symptomless encephalorrhagia can becured. So, SIT is a effective method in the treatment of superacute ischemic stroke.