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目的探讨超选择性动脉溶栓联合血管内干预治疗急性缺血性脑卒中的疗效和安全性。方法回顾分析我院住院治疗的21例进行超选择性动脉溶栓的急性缺血性脑卒中患者的临床资料。结果21例患者中,颈内动脉系统病变16例,其中颈内动脉闭塞2例,大脑中动脉主干及分支闭塞6例,大脑前动脉闭塞1例,脑血管造影未见异常者7例。椎基底动脉闭塞5例,闭塞血管再通者,大脑中动脉4例,椎基底动脉2例。其中7例患者动脉溶栓的同时进行了血管内治疗,5例球囊成形术和2例支架植入术。临床症状完全恢复7例,明显好转或进步8例,无效3例,死亡3例;溶栓后脑出血2例,存活病例无1例并发脑出血及消化道出血。结论对选择的急性缺血性脑卒中患者进行超选择性动脉溶栓联合血管内干预治疗是安全有效的。
Objective To investigate the efficacy and safety of super selective arterial thrombolysis and intravascular intervention in the treatment of acute ischemic stroke. Methods The clinical data of 21 patients with acute ischemic stroke who underwent superselective arterial thrombolysis in our hospital were retrospectively analyzed. Results Among the 21 patients, there were 16 cases of internal carotid artery disease, including 2 cases of internal carotid artery occlusion, 6 cases of middle cerebral artery trunk and branch occlusion, 1 case of anterior cerebral artery occlusion and 7 cases of abnormal cerebral angiography. Vertebrobasilar artery occlusion in 5 cases, occlusive vascular recanalization, 4 cases of middle cerebral artery, vertebrobasilar artery in 2 cases. Seven of the patients underwent arterial thrombolysis simultaneously with endovascular treatment, five with balloon angioplasty and two with stent placement. Clinical symptoms were completely recovered in 7 cases, markedly improved or improved in 8 cases, 3 cases were ineffective, 3 died; 2 cases of intracerebral hemorrhage after thrombolysis, none of the surviving cases complicated by cerebral hemorrhage and gastrointestinal bleeding. Conclusions Superselective arterial thrombolysis combined with endovascular intervention is safe and effective for patients with acute ischemic stroke.