球囊导管联合替罗非班对颅内动脉慢性闭塞再通介入的研究

Research of balloon catheter combined with Tirofiban for recanalization interventional therapy of chronic occlusion of intracranial artery

目的研究经球囊导管扩张后联合替罗非班对颅内动脉慢性闭塞再通介入治疗的效果。方法 65例颅内动脉慢性闭塞双抗治疗效果不明显、近期内反复脑缺血发作或出现新血栓患者,随机分为研究组(32例)和对照组(33例)。研究组患者采用微创方法经球囊导管对病变部位进行全段扩张(必要时)建立前向血流,再联合替罗非班治疗;对照组患者采用保守药物治疗。比较两组患者脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP),治疗前后美国国立卫生院卒中量表(NIHSS)评分,治疗效果。结果 1周后,研究组患者CBF明显高于对照组, MTT、TTP明显短于对照组,差异具有统计学意义(P<0.05)。研究组患者治疗总有效率为90.63%,高于对照组的57.58%,差异具有统计学意义(P<0.05)。两组患者治疗前NIHSS评分比较差异无统计学意义(P>0.05);研究组患者治疗后NIHSS评分为(8.9±1.1)分,明显低于对照组的(16.5±2.8)分,差异具有统计学意义(P<0.05)。结论经球囊导管扩张后联合替罗非班对颅内动脉慢性闭塞行再通介入治疗,闭塞远端的低灌注脑组织重新得到脑血流,从而使脑细胞功能得以恢复,责任血管远端再发脑梗死的几率明显降低。

Objective To research the effect of percutaneous balloon catheter dilatation combined with Tirofiban for recanalization interventional therapy of chronic occlusion of intracranial artery. Methods A total of 65 patients with chronic intracranial artery occlusion who had no obvious therapeutic effect, recurrent ischemic attack or new thrombosis in the near future were randomly divided into research group for 32 cases and control group for 33 cases. Patients in the research group were treated with a minimally invasive method, complete dilatation（if necessary） of the lesion site by percutaneous balloon catheter, and then combined with Tirofiban. Patients in the control group were treated with conservative medicine. The cerebral blood flow（CBF）, mean transit time（MTT） and time to peak（TTP）, the national institutes of health stroke scale（NIHSS） score before and after treatment, therapeutic effect between the two groups were compared. Results After one week, The CBF of the research group was significantly higher than that of the control group, the MTT and TTP of the research group were significantly shorter than those of the control group, the differences were statistically significant（P〈0.05）. The total effective rate of the research group was 90.63%, which was significantly higher than 57.58% of the control group, the difference was statistically signficant（P〈0.05）. The NIHSS score of the research group was（8.9±1.1） scores, which was significantly lower than（16.5±2.8） scores of the control group, the difference was statistically significant（P〈0.05）. Conclusion Percutaneous balloon catheter dilatation combined with Tirofiban for recanalization interventional therapy of chronic occlusion of intracranial artery, hypoperfusion of the occluded distal cerebral tissue regained cerebral blood flow, thus restoring the function of brain cells, and significantly reducing the risk of recurrent cerebral infarction in the responsible distal vessels.