动脉溶栓联合血管内支架置入术治疗急性脑梗死的临床研究

Clinical research of intra-arterial thrombolysis combined with endovascular stent implantation in the treatment of acute cerebral infarction

目的评价动脉溶栓联合血管内支架置入术治疗因动脉狭窄导致其急性闭塞的急性脑梗死的临床疗效及安全性。方法选择40例合并动脉狭窄的急性脑梗死患者,前循环系统病变13例(其中颈内动脉病变9例,大脑中动脉病变3例,大脑前动脉病变1例),后循环系统病变27例,均采用尿激酶选择动脉溶栓,然后对明显的残余血管狭窄,采用血管内支架成形术治疗。结果术后血管再通率为100%,支架定位准确,血管残余狭窄<20%,临床症状完全恢复或明显好转率为67.5%;溶栓后脑出血6例(15.0%),而且术前的神经功能缺损评分(NIHSS)评分越高,治疗有效率越低,差异具有统计学意义(P<0.05);随着治疗开始时间的延长,治疗有效率降低(P<0.05)。结论对动脉狭窄导致其急性闭塞的急性脑梗死患者进行选择动脉溶栓联合血管内支架置入术是安全有效的,而且该治疗方法的有效率与术前的NIHSS评分及治疗时间相关。

Objective To evaluate the clinical effect and safety of intra-arterial thrombolysis combined with endovascular stent implantation in the treatment of acute cerebral infarction induced by arteriostenosis. Methods Among 40 patients of acute cerebral infarction complicated with arteriostenosis, there were 13 cases with anterior circulation system lesion （9 cases with internal carotid lesion, 3 cases with middle cerebral artery lesion, 1 ease with anterior Cerebral artery）, and 27 cases with posterior circulation system lesion. They all received urokinase for intra-arterial thrombolysis firstly. Endovascular stent implantation was applied for remnant arteriostenosis. Results Postoperative revascularization rate was 100%. The stent had precise location with remnant arteriostenosis 〈20%. The rate of complete recovery or obvious improvement in clinical symptom was 67.5%. There were 6 cases with cerebral hemorrhage after thrombolysis （15.0%）, and their effective rate of treatment was lower due to higher national institutes of health stroke scale （NIHSS score） before treatment. The difference had statistical significance （P〈0.05）. The total effective rate was also lower because of later start time of treatment, and the difference had statistical significance （P〈0.05）. Conclusion The combination of intra-arterial thrombolysis and endovascular stent implantation is safe and effective in the treatment of acute cerebral infarction induced by arteriostenosis. Its effective rate is also correlated with preoperative NIHSS score and treatment time.