经局部动脉内溶栓治疗急性脑梗死

目的　研究经血管内选择性溶栓治疗 49例 8h内发病的急性脑梗死患者 ,以评估动脉内溶栓治疗急性脑梗死的疗效。方法　患者均急诊行头颅CT检查 ,31例经股动脉插管 ,全脑血管造影确认脑梗死 ,再选择性将导管插入患侧颈内动脉和椎动脉并注入尿激酶 5 0～ 75万单位行接触性和区域性溶栓治疗。对照组 18例行常规治疗。结果　溶栓后血管再通率为 71% ,有效率为 83%。 2 3例颈内动脉系和 4例椎基动脉系梗死在溶栓后 2周内神经损害体征明显改善 ,2例死亡。溶栓组改良爱丁堡 斯堪的纳维亚脑卒中量表 (MESSS)评分改善 (2 1.6± 13.6 )分 ;对照组改善 (5 .9± 5 .3)分。溶栓组发病时间越短其疗效越好。结论　选择性动脉内溶栓治疗是一种治疗急性脑梗死的有效方法 ,具有较高的血管再通率

Local Intra-arterial thrombolysis for treatment of acute cerebral infarction

Objective To evaluate the efficacy of selective endovascular thrombolysis in treatment of patients with acute cerebral infarction.Methods Forty-nine patients with acute cerebral infarction within 8 h after onset were divided into thrombolysis group(n=31)and control group(n=18).For thrombolysis,a catheter was selectively introduced into the ipsilateral internal carotid artery or vertebral artery via femoral artery in each case and the tip of a Tracker-18 catheter was advanced into the thrombus or upstream from the occlusion site. Urokinase 500?000～750?000 U was injected for contact or local thrombolytic therapy. The control therapy was almost same as the therapy for thrombolysis group except urokinase.Results In thrombolysis group, the rate of recanalization was 71% and the effective rate was 83%.Four cases with vertebral basilar artery occlusion and 23 cases with cervical artery system occlusion were greatly improved in 14 days after thrombolysis and 2 cases died. MESSS score was significantly decreased in thrombolysis group (decreased by 21.6±13.62 points) as compared with control group(5.95±5.36 points).Conclusion Emergency local intra-arterial and contact thrombolysis in ipsilateral ICA and vertebral artery is a favourable and effective therapeutic method for acute cerebral infarction with high rate of recanalization.