觉醒型缺血性卒中进展后动脉内治疗1例并文献复习

Endovascular therapy in progressive wake-up stroke:a case report and literature review

目的探讨多模式影像学选择的觉醒型缺血性卒中(WUS)患者进行静脉溶栓以及动脉内治疗的临床疗效。方法解放军第306医院对1例WUS患者进行静脉溶栓桥接动脉取栓并急诊支架成形术治疗,随访90天,将临床资料进行总结与分析。结果经过静脉溶栓后患者症状部分缓解,很快再次加重,随即进行动脉取栓并发现责任大脑中动脉重度狭窄,取栓后血流不能维持,给予急诊支架植入。病情演变过程复杂,最终结局良好,神经功能缺损改善。90天随访:患者痊愈,NIHSS 0分,mRS 0级。结论对于WUS患者,通过多模式影像学选择后进行静脉溶栓以及动脉内治疗是安全有效的。

Objective To investigate the clinical efficacy of intravenous thrombolysis and endovascular therapy in Wake-up stroke(WUS)patients selected by multi-mode imaging.Methods One WUS patient was treated with intravenous thrombolytic bridging arterial thrombolysis and emergency stent implantation in the 306 th Hospital of PLA and followed up for 90 days.The clinical data were summarized and analyzed.Results After intravenous thrombolysis,the symptoms were partially relieved,but aggravated again.Then thrombectomy was performed and severe middle cerebral artery stenosis was found.After thrombectomy,the blood flow could not be maintained and emergency stent implantation was given.The course of the disease was complex,however,the final outcome was good.The patient recovered with NIHSS 0 score and mRS 0 level in 90 days follow-up.Conclusion For WUS patients,intravenous thrombolysis and endovascular therapy are safe and effective after multi-mode imaging.