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目的探讨动脉内应用尿激酶溶栓治疗急性颈内-大脑中动脉闭塞性脑卒中的安全性和有效性。方法回顾性分析1998年3月～2006年8月急诊超选择动脉内溶栓治疗患者中颈内及大脑中动脉完全闭塞的病例38例,男性28例,女性10例,年龄47～76岁,平均61.5岁。起病到接受治疗的时间为6h以内,尿激酶以1万～1.2万U/min持续泵入,总量为50万～150万U,平均87.5万U。结果单纯颈内动脉主干闭塞型6例,颈内动脉包括分叉部闭塞的T型12例,大脑中动脉近端闭塞的M1型13例和大脑中动脉远端闭塞的M2型7例。38例中再通25例,再通率为65.8%。术后3个月随访:mRS评分≤3分者24例,其中T型6例,单纯颈内动脉主干闭塞型5例,M1型7例,M2型6例,良好恢复率为63.2%。5例死亡,其中T型3例,M1型2例,病死率为13.2%。术后并发脑出血4例,其中T型和M1型各2例,占10.5%。结论超选择动脉内溶栓能够尽快使闭塞的血管再通,改善预后,是一种治疗急性颈内-大脑中动脉闭塞性脑卒中的安全、有效的方法。
Objective To investigate the safety and efficacy of intra-arterial urokinase thrombolysis in the treatment of acute intracranial-middle cerebral artery occlusive stroke. Methods A retrospective analysis of 38 patients with complete occlusion of the internal carotid artery and middle cerebral artery in patients undergoing transcatheter arterial thrombolysis in the emergency department from March 1998 to August 2006 was performed. Among them, 28 were males and 10 were females, ranging in age from 47 to 76 years. Average 61.5 years old. From onset to treatment within 6h, urokinase with 10,000 to 12,000 U / min continuous pumping, the total amount of 500,000 to 1,500,000 U, an average of 875,000 U. Results Six cases of simple internal occlusion of internal carotid artery, 12 cases of internal carotid artery included T-type occlusion of bifurcation, 13 cases of M1 occluded in the middle cerebral artery and 7 cases of M2 occluded in the distal middle cerebral artery. Thirty-eight of the patients recanalized, and the recanalization rate was 65.8%. Three months after operation, 24 patients had mRS score ≤3, of which 6 were type T, 5 were occlusive occlusion of internal carotid artery, 7 were type M1 and 6 were type M2, with a good recovery rate of 63.2%. 5 patients died, of which 3 cases of T type, M1 type 2 cases, the mortality rate was 13.2%. There were 4 cases of intracerebral hemorrhage after operation, of which 2 cases were type T and M1, accounting for 10.5%. Conclusion Superselective intra-arterial thrombolysis can quickly lead to occlusion of blood vessels and improve prognosis. It is a safe and effective method for the treatment of acute intracranial-middle cerebral artery occlusive stroke.