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目的观察超选择性动脉溶栓联合血管内支架成形术治疗合并动脉狭窄的急性脑梗死的临床疗效及安全性。方法选择2009年10月~2013年10月在西安交通大学第二附属医院神经内科对动脉溶栓[尿激酶或重组人组织型纤溶酶原激活剂(rt-PA)]再通后残存严重狭窄(狭窄率>70%)的18例急性脑梗死行血管内支架成形术治疗患者为研究对象,术后即刻血管造影评估支架定位及血管残余狭窄率。采用美国国立卫生研究院卒中量表(NIHSS)评分评估患者治疗前、后神经功能缺损程度,3月后应用改良Rankin量表(mRS)评分评估患者预后。术后电话或门诊随访,平均随访时间(18.18±10.37)(6~48)个月。结果所有支架定位准确,血管残余狭窄率<20%。治疗后神经功能缺损程度评分较治疗前明显改善(P<0.05),3个月后mRS评分明显改善。1例(5.6%)在术后第4 d仍处于昏迷状态,家属放弃治疗,死于脑干梗死。1例(5.6%)术后10个月出现神经定位体征,但临床表现明显较首次发病轻,复查DSA提示支架处血管闭塞。结论早期超选择性动脉内溶栓联合血管内支架成形术治疗合并动脉狭窄的急性脑梗死患者的方法安全、有效。
Objective To observe the clinical effect and safety of super selective arterial thrombolysis and endovascular stenting in the treatment of acute cerebral infarction complicated by arterial stenosis. METHODS: From October 2009 to October 2013, the residual thrombolytic activity of urokinase or recombinant human tissue plasminogen activator (rt-PA) in the Second Affiliated Hospital of Xi’an Jiaotong University after recanalization Eighteen cases of acute cerebral infarction with stenosis (stenosis rate> 70%) underwent endovascular stenting were included in the study. Postoperative angiographic assessment of stent placement and residual vascular stenosis was performed. The National Institutes of Health Stroke Scale (NIHSS) score was used to assess the degree of neurological deficits in patients before and after treatment. The prognosis was evaluated after 3 months by the Modified Rankin Scale (mRS) score. Postoperative phone or outpatient follow-up, the average follow-up time (18.18 ± 10.37) (6 to 48) months. Results All the stents were positioned accurately and the residual vascular stenosis rate was less than 20%. After treatment, the score of neurological deficit was significantly improved (P <0.05), and the mRS score was significantly improved after 3 months. One patient (5.6%) was still unconscious on the 4th day after operation. The family members abandoned the treatment and died of infarction in the brainstem. One patient (5.6%) had neurological signs at 10 months postoperatively, but the clinical manifestations were significantly lower than those of the first onset. The DSA scan indicated that the stent occluded. Conclusion Early superselective arterial thrombolysis combined with endovascular stenting in the treatment of patients with acute cerebral infarction complicated by stenosis is safe and effective.