机械取栓治疗兔急性栓塞性脑梗死的实验研究

Effectiveness of mechanical thromboectomy versus intravenous thrombolytic therapy for acute thromboembolic cerebral infarct in adult rabbits

目的探讨机械取栓治疗兔急性栓塞性脑梗死的效果。方法将30只新西兰大白兔应用血流阻断加注射凝血酶方法制作兔右颈总动脉栓塞模型,然后将其随机分为取栓组、溶栓组和对照组,每组10只。造模成功后3 h,取栓组行机械取栓治疗,溶栓组应用重组组织型纤溶酶原激活剂行动脉内溶栓治疗,对照组不治疗。取、溶栓前后行DSA了解血管再通情况;比较取、溶栓前后大脑中动脉流速(Vmca)及各组栓塞后3、6、8、12、24 h磁共振弥散系数(ADC)值的差异;比较各组24 h神经功能评分。结果取栓组和溶栓组血管再通率分别是80%和20%,差异有统计学意义(P<0.05)。取栓组和溶栓组治疗后Vmca显著增快(P<0.05),取栓组增加更显著(P<0.05)。取栓组和溶栓组24 h ADC值、神经功能评分较治疗前显著改善(P<0.05),取栓组改善更显著(P<0.05)。结论取栓治疗急性栓塞性脑梗死安全、有效,疗效优于血管内溶栓治疗。

Objective To explore the effectiveness of mechanical thromboectomy （MT） versus intravenous thrombolytic therapy （IVTT） for acute thromboembolic cerebral infarct （ATECI） in adult rabbits. Methods The animal model of ATECI was made by embofized the right common carotid arteries of 30 rabbits. Then the rabbits were randomly divided into three groups, i.,e., MT group （n= 10）, IVTT group （n=10） and control group （n=10）. The rabbits in IVTT group received recombinant human tissue-type plasminogen activator （0.9 mg/kg） and the rabbits in MT group received mechanical thrombectomy 3 hours after embolization. The rabbits in control group did not receive any treatment. The middle cerebral artery flow velocity was measured by the transcranial Doppler ultrasound. The diffusion-weighted magnetic resonance imagings were performed in all rabbits 3, 6, 8, 12 and 24 hours after embolization and the apparent diffusion coefficients （ADCs） were calculated. The neurological function was assessed 24 hours after embolization using Tarlov grade. Results The overall recanalization rate in MT group （80%） was significantly higher than that （20%） in IVTT group （P〈0.05）. The rebleeding rate in MT group （0） was significantly lower than that （10%） in IVTT group （20%; P〈0.05）. The middle cerebral artery flow velocity was significantly lower in control group than that in IVTT group which was significantly lower than that in MT group after treatment （P〈0.05）. The middle cerebral artery flow velocities were significantly increased both in MT and IVTT groups after treatment compared with before treatment （P〈0.05）. The ADCs significantly increased in MT group 24 hours after embolization （P〈0.05）, but they significantly decreased both in IVTT and control groups （P〈0.05）. The neurological function significantly improved in MT group compared with IVTT and control groups （P〈0.05）, but there were no significant difference between IVTT and control groups （P〉0.05）. Conclusions Both MT and IVTT are effective and safe treatment method for the ATECI in adult rabbits. MT is superior to IVTT for treatment of the ATECI in adult rabbits.