脑栓塞急诊溶栓与颅内支架成形术的临床应用

Combined intraarterial thrombolysis and intra-cerebral stent for acute ischemic stroke institute of brain vascular diseases

目的 探讨脑栓塞急诊溶栓与支架联合应用的必要性和可行性。方法 全部选择2 0 0 1年 5月～ 2 0 0 2年 8月急诊溶栓后行支架治疗的 19例病例患者。其中大脑中动脉 9例 ,基底动脉10例。先行大脑中动脉或基底动脉溶栓 ,然后用心脏支架 ,行溶栓后血管狭窄段的支架成形术。结果 19例溶栓术后显示血管狭窄 ,平均狭窄 85 % ;术后影像学显示血管形态良好 ,无残留狭窄 ,临床症状好转或消失。 1例术后 2 4h支架内血栓形成。余 18例再无TIA发作 ,TCD复查血流正常。结论 急诊溶栓后进行支架治疗可有效的预防血管的再度闭塞 ,降低TIA的发生率。

Objective To test feasibility, safety and efficacy of combined intraarterial thrombolysis and intra cerebral stent for acute ischemic stroke. Methods From 2001 5 to 2002 8, 19 patients with acute onset of stroke were treated with intraaterial thrombolysis followed by intra cerebral stent. 9 located in middle cerebral artery (MCA), 10 located in basal artery (BA). For each patient, intraarterial thrombolysis of MCA or BA was applied at first, stent angioplasty was applied at the stenosis left after the thrombolysis by using the stent for coronary artery. Results All the 19 patients left stenosis after intraaterial thrombolysis, and the average stenosis was 85% in diameter. After the operation of stent, the images showed the vascular is smooth and had no stenosis left. The symptoms were disappeared or improved. Thrombus formation in the stent occurred on 1 patient 24 hours after the operation. TIA never occurred in the left 18 patients then. TCD follow up showed blood flow is normal. Conclusions It is feasibility of intraaterial thrombosis followed by intra cerebral stent. And it is valid for preventing occlusion again of the vessel and decreasing the rate of TIA occurring.