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目的分析尿激酶动脉内溶栓联合血管内干预治疗急性脑梗死的疗效和安全性。方法回顾分析我科住院治疗13例患者进行尿激酶动脉内溶栓及血管内干预治疗的急性脑梗死患者临床资料。结果 13例患者中,颈动脉系统病变11例,其中颈内动脉闭塞2例,大脑中动脉主干及分支闭塞8例,大脑前动脉闭塞1例(包含脑血管造影未见异常者3例),椎基底动脉闭塞2例。溶栓开始时间3～12h,平均7.5h,其中10例在6h内开始。使用尿激酶30万～100万U,平均70万U。溶栓后2例给予血管内支架治疗,4例给予球囊扩张血管成形治疗。基本痊愈5例,显著进步5例,无效3例。闭塞血管成功再通7例,未成功再通3例。并发脑出血1例,死亡1例,无并发消化道出血等其他情况。结论对急性脑梗死患者进行尿激酶动脉内溶栓联合血管内干预治疗是安全有效的。
Objective To analyze the efficacy and safety of intra-arterial thrombolytic therapy combined with intravascular intervention for the treatment of acute cerebral infarction. Methods The clinical data of 13 patients with acute cerebral infarction undergoing thrombolytic therapy of urokinase and endovascular intervention in our hospital were retrospectively analyzed. Results Among the 13 patients, there were 11 cases of carotid system disease, 2 cases of internal carotid artery occlusion, 8 cases of middle cerebral artery trunk and branch occlusion, 1 case of anterior cerebral artery occlusion (including 3 cases without cerebral angiography) Vertebrobasilar occlusion in 2 cases. Thrombolytic start time 3 ~ 12h, an average of 7.5h, of which 10 cases started within 6h. Urokinase 30 million to 1 million U, an average of 700,000 U. After thrombolytic therapy, 2 cases were treated with endovascular stent and 4 cases were given balloon dilation angioplasty. The basic recovery in 5 cases, significant progress in 5 cases, 3 cases. Successful occlusion of vascular recanalization in 7 cases, failed to pass again in 3 cases. 1 case of intracranial hemorrhage, 1 case of death, no other cases of gastrointestinal bleeding. Conclusion It is safe and effective to treat patients with acute cerebral infarction by intra-arterial thrombolysis combined with intravascular intervention.