中国脑血管病杂志2013，Vol.10Issue(8)：406-409,420,5.DOI:10.3969/j.issn.1672-5921.2013.08.003
动脉溶栓联合血管成形术治疗急性重症缺血性卒中患者疗效分析
Efficacy analysis of intraarterial thrombolysis in combination with angioplasty in the treatment of patients with severe acute ischemic stroke
摘要
Abstract
Objective To investigate the clinical efficacy and safety of intraarterial thrombolysis in combination with angioplasty in the treatment of severe ischemic stroke.Methods A total of 16 patients with severe acute ischemic stroke (the National Institutes of Health Stroke Scale[NIHSS] score 18 [14 to 21]),the modifed Rankin scale [mRS] score 4 [3 to 5]) who had poor recanalization after arterial thrombolysis (urokinase) alone underwent angioplasty in Beijing Xuanwu Hospital,Capital Medical University from September 2009 to April 2023.Six of them performed balloon angioplasty,3 performed stenting alone,and 7 performed balloon dilatation plus stenting.Results ①14 (87.5％) of the 16 patients had preoperative blood flow perfusion (TIMI) grade 0 and 2 (12.5％) had grade 1.Fourteen patients had recanalization after procedure.The total recanalization rate was 87.5％ (14/16),11 (68.8％) of them had complete recanalization and 3 (12.5％) had partial recanalization.Seven patients performed balloon dilatation plus stenting,they were all had complete recanalization; 3 had stenting alone,2 had complete recanalization,1 had partial recanalization; 6 had balloon angioplasty alone,2 had complete recanalization,2 had partial recanalization,and 2 did not recanalized (TIMI grade from 0 to 1).②2 patients (12.5％)died after procedure,1 died of cerebellum and brain stem hemorrhage at day 5 after procedure,and another died of subarachnoid hemorrhage at day 6 after procedure.③14 patients survived,their NIHSS and mRS scores at 2 weeks after procedure were improved significantly compared to before procedure.At 3 months after procedure,the NIHSS and mRS scores were further improved than that at 2 weeks after procedure.The differences were statistically significant (P ＜ 0.01 or P ＜ 0.05).Fourteen patients were followed up for 19.5 (3 to 46) months using ultrasonography,after balloon dilatation,only 1 patient had restenosis.Conclusion In patients with severe acute ischemic stroke and poor recanalization after intraarterial thrombolysis alone,it combination with angioplasty may increase the recanalization rate and improve clinical outcomes.In combination with stenting may have higher recanalization rate compared to balloon angioplasty alone.关键词
卒中/脑缺血/急性/血管成形术/动脉溶栓Key words
Stroke / Brain ischemia, acute/ Angioplasty / Intraarterial thrombolysis引用本文复制引用
孙智善,孟然,焦力群,李思颉,张鸿祺,陈健,吉训明..动脉溶栓联合血管成形术治疗急性重症缺血性卒中患者疗效分析[J].中国脑血管病杂志,2013,10(8):406-409,420,5.基金项目
国家自然科学基金资助项目(30770741) （30770741）
北京市高层次人才基金(2009-03-02) （2009-03-02）
