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目的根据脑血管造影结果的分类分型,初步探讨超选择动脉内溶栓治疗急性脑缺血性卒中的适应证。方法回顾1998年3月至2006年8月,急诊超选择动脉内溶栓治疗患者87例,男63例,女24例,年龄36~80岁,平均58岁;起病到接受治疗的时间为6小时以内;尿激酶以1~1.2万U/min持续泵入,总量为50~150万U,平均87.5万U。结果把脑血管造影的结果按闭塞程度分为完全闭塞、狭窄、未见异常三类。完全闭塞55例,狭窄组15例,未见异常组17例。闭塞组中,按责任血管和闭塞部位分,颈内动脉组18例,再通11例,溶通率为61.1%;大脑中动脉组20例,再通14例,溶通率为70%;椎-基底动脉型组12例,再通8例,溶通率为66.7%;双侧颈动脉系统多血管或伴椎-基底动脉系统血管明显病变者称为多发型,多发型5例中再通2例,溶通率为40%。神经功能评价:闭塞组35例再通患者中24例改善,占68.6%;闭塞未溶通者22例,5例改善,占22.7%;完全闭塞而由对侧代偿和或侧支循环形成者9例中1例恶化;狭窄组13例改善,2例无变化;未见异常组15例改善,1例无变化,1例恶化。结论超选择动脉内溶栓能够尽快使闭塞的血管再通,是治疗完全闭塞的急性缺血性脑卒中的一种有效方法。尤其适合心源性栓塞者、椎-基底动脉闭塞及颈内动脉闭塞而由对侧代偿和或侧支循环形成者。
Objective To investigate the indications for the treatment of acute cerebral ischemic stroke by superselective intra-arterial thrombolysis according to the classification of cerebrovascular angiography. Methods From March 1998 to August 2006, 87 patients undergoing transcatheter arterial thrombolysis in the emergency department were enrolled. There were 63 males and 24 females, aged from 36 to 80 years (mean 58 years). The time from onset to treatment was 6 hours; urokinase with 1 to 12,000 U / min continuous pumping, the total amount of 50 to 1,500,000 U, an average of 875,000 U. The results of cerebral angiography results according to the degree of occlusion is divided into complete occlusion, stenosis, no abnormalities in three categories. Complete occlusion in 55 cases, 15 cases of stenosis, no abnormal group of 17 cases. In the occlusion group, according to the responsible vessels and occlusion sites, 18 cases were treated with internal carotid artery and 11 cases with recanalization. The rate of dissolve-through was 61.1%. In the middle cerebral artery group, 20 cases were recanalized, and the dissolution rate was 70%. Vertebrobasilar artery type group, 12 cases, recanalization in 8 cases, the rate of pass-through was 66.7%; bilateral carotid artery or vascular system with vertebral-basilar artery obvious lesions were called multiple, multiple in 5 cases and then In 2 cases, the dissolution rate was 40%. Neurological evaluation: In the occlusion group, 24 of the 35 recanalization patients improved, accounting for 68.6%; 22 cases of occlusive non-recanalization, 5 cases improved, accounting for 22.7%; completely occluded and formed by contralateral compensation or collateral circulation One of 9 patients deteriorated; 13 patients improved in stenosis group, 2 patients showed no change; 15 patients showed no improvement in abnormal group, 1 patient did not change and 1 patient deteriorated. Conclusion Superselective intra-arterial thrombolysis can prompt the recanalization of occluded blood vessels and is an effective method for the treatment of complete occlusion of acute ischemic stroke. Especially suitable for cardiac embolism, vertebrobasilar artery occlusion and occlusion of the internal carotid artery by the contralateral compensation and or collateral circulation formation.