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Urgent intra-atrerial thrombolytic therapy for acute ischemic stroke
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张青 金征宇 黄一宁 崔丽英 杨宁
刘巍 潘杰 高山 叶健 徐蔚海
刘芳检 王乐英 陈君 戴建平
中国医学科学院北京协和医科大学
北京协和医院放射科，100730
Qing Zhang , Zhengu Jin , Yining Huang , Liying Cui , Ning Yang , Wei Liu , Jie Pan , Shan Gao , Jian Ye , Weihai Xu , Fangjian Liv , Leying Wang , Jun Chen , Jianping Dai.
Department or Radiology, Beijing Peking Union Hospital,Medical Academy Sciences or Ching, Beijing Peking Union Medical College , Beijing Peking Uniom Medical College,Biejing 100730,China
Abstract
Objective: We report the results or urgent intra-arterial thrombolysis(IAT)in patients within6 h or acute ischemic stroke onset.The purpose or the study was to obseme the sardty and efficacy of IATandto analysis the predictive factors related to the outcome .
Methods: 25 Patiepis were treated by IAT using urokinase(UK)or recombinant Streptokinase(r-SK)in our hospital. Primary meuroradiological assessment was performed with CT in all patients.Mechanical disruption or clot remnants was attempled arter UK or r-SK was intused.Amgiographic recanaliszation was classified according to Thrombolysis In Myocardial Ifarction (TIMI) grades.Clinical outcome was classified as good for Modified Rankin Scale(MRS) scores or 0 to 3 and poor for MRS scores or 4 to 6.
Results: There are 18(72) or the 25 patients had good outcome, 7(28)had poor outcome.Cerebral hemorrhage occurred in 4 of the 25 patients,all with poor outcome.
Concluslon: Intra-arterial thrombolysis(IAT) is feasible and safe in the setting or acute stroke.Collateral ciroulation,recanalization and improvement by 4 or fhore points on NIHSSS within 24 hours were significantly associated with good outcoml, there was sigmificantly association between no recanalization and cerebral bemorrhage and death.The key to improve the effect or IAT was successful recanalization.
Key words：Cerebral inrarction; Acute dise; Thromblytion therapy; Radiology, interventional; Evaluation studies.
脑卒中是严惩危害人类健康的疾病之一。1998年美国约60万人患脑卒中，为导致长期严惩残疾的首位原因[1]。1999年我国脑血管病残废率在城市仅次于恶性肿瘤，在农村排第3位，脑血管病为城市女性首位死因[2]。
83%的脑卒中是由于脑动脉急性闭塞导致的缺血性脑梗死[1]。早期再通闭塞动脉，尽快恢复缺血半暗带区域血供，尽量挽救神经功能成为其治疗目的。已进行的多个随机双盲多中心安慰剂对照的动静脉溶栓治疗实验正以其确切的疗效越来越引起人们的高度重要[3,4]。
笔者观察了急诊动脉内溶栓（IAT）治疗急笥缺血性脑梗死的近期疗效及并发症，通过分析预后相关因素探讨IAT治疗的病例选择标准及尽早对其预后做出判断的方法。
材料与方法
一、 患者选择
1、适应证：发病在6h内或最近4h脑卒中症状明显加重；年龄大于18岁，小于78岁，治疗前的美国国立卫生研究所卒中分数（NIHSSS）≥4分，有确切神经系统定位体征(如偏瘫、单肢全瘫痪、失语等); 脑CT排除颅内出血和其他非血管性异常，未见明显低密度区域。
2、禁忌证：NIHSSS大于30分；临时工床表现提示为蛛网膜下腔出血(即使开始时CT扫描正常): 急诊应用硝普钠治疗后血压仍高于200/120mmHg(1mm Hg=0.133kpa): 有颅内出血史、脑瘤脑史; 怀疑有脓毒性栓子或心内膜炎; 30d内有手术史; 14d内有出血史; 已知的遗传性或获得性出血体质; 纤维蛋白原小0.12kg/L，或凝血酶原时间大于20s; 严重工业的心、肺、肝、肾疾病。
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