急性脑梗塞动脉溶栓及经皮腔内血管成形术治疗

Combined treatment of selective intravascular thrombolysis and perculaneous transluminal angioplasty for acute ischemic stroke

目的：评价超选择动脉溶栓及经皮腔内血管成形术（ＰＴＡ）治疗急性脑梗塞的临床疗效。方法：对３０例急性脑梗塞病人，经股动脉或颈动脉插管，用微导丝将微导管送至血管闭塞部位，注入尿激酶（ＵＫ）行溶栓治疗，对６例颅外段血和狭窄者，采用ＰＴＡ消除，并注入罂粟碱扩张颅内血管。结果：颈内动脉闭塞１０例、大脑中动脉１６例、椎基动脉系统４例中，血管完全再通１５例，部分再通１２例，治疗３月后日常生活能力指数（ＢＩ）评分：１００分２０例，７５～９５分６例，占３６．６７％。结论：早期超选择动脉溶栓配合ＰＴＡ和罂粟碱可明显提高闭塞血管再通率，是目前治疗急性脑梗塞最有效的方法。

Objective: To evaluate the therapeutic effect of the selective intraarterial thrombolysis (SIT) and perculaneous transluminal angioplasty (PTA) for acute ischemic stroke. Methods: 30 patients with acute ischemic stroke had been treated. Making the microguidewire pass through and reach to the embolus, removing the microguidewire then the thrombolysis therapy was performed by local intravascular infusion of urokinase at the site of occlusion. PTA was used to eliminate the stenosis in extracranial arterial in 6 cases, combined with infusion of papvinine. Results: Among the 10 cases with occlusion of internal carotid artery, 16 with occlusion of middle cerebral artery and 4 with occlusion of vertebralis artery, 15 cases were completely recanalized, 12 cases were partially recanalized. three month after treatment the recovery rate of neurologic deficits was 86.67% (26/30). Conclusions: SIT combined with PTA and papaverine is a effective method in the treatment of acute ischemic stroke.