急性颅内大动脉闭塞患者血管内治疗前行静脉溶栓的可行性

Feasibility study of intravenous thrombolysis before intravascular therapy in patients with acute intracranialartery total occlusion

目的:探究急性颅内大动脉闭塞(AIATO)患者血管内治疗前行静脉溶栓的可行性。方法:选取206例AIATO患者为研究对象,根据治疗方案不同将患者分为对照组(n=103)与观察组(n=103)。对照组给予直接血管内治疗;观察组给予阿替普酶静脉溶栓联合血管内治疗(桥接治疗)。比较两组患者血管再通情况、美国国立卫生院卒中量表(NIHSS)评分、预后情况及不良反应发生情况。结果:观察组发病至血管再通时间短于对照组(P<0.05),血管再通率高于对照组(P<0.05)。两组患者NIHSS评分均随时间发展而逐渐降低;治疗后24 h、7 d,观察组的NIHSS评分均低于对照组(P<0.05)。治疗后3个月,观察组患者改良Ranin量表(mRS)评分低于对照组(P<0.05),预后情况优于对照组(P<0.05)。两组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:AIATO患者血管内治疗前行静脉溶栓可有效促进血管再通,促进神经功能恢复及预后改善,且安全性较好。

Objective:To explore the feasibility of intravenous thrombolysis before intravascular therapy in patients with acute intracranialartery total occlusion(AIATO).Methods:206 AIATO patients were selected and divided into control group(n=103)and observation group(n=103)according to the different treatment methods.Direct intravascular therapy was used in the control group,and intravenous thrombolysis with alteplase combined with intravascular therapy(bridging therapy)was used in the observation group.The vascular recanalization,national institutes of health stroke scale(NIHSS)score,prognosis and occurrence of untoward effects of both groups were compared between the two groups.Results:The time from onset to vascular recanalization of observation group was shorter compared with the control group(P<0.05),and the vascular recanalization rate was higher compared with the control group(P<0.05).The NIHSS scores of both groups were gradually decreased over time,and the NIHSS scores of observation group at 24 h and 7 d after therapy were lower compared with the control group(P<0.05).The modified ranin acale(mRS)score of the observation group at 3 months after therapy was lower compared with the control group(P<0.05),and the prognosis was better compared with the control group(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Intravenous thrombolysis before intravascular therapy in AIATO patients can effectively promote the vascular recanalization,the recovery of neurological function and prognosis improvement,with a good safety.