尿激酶静脉溶栓联合Solitaire AB支架取栓在前循环大动脉急性闭塞性脑梗死治疗中的应用研究  

Study on effect application of venous urokinase thrombolysis combined with stent-thrombectomy in treating patients with acute anterior circulation of cerebral infarction

作　　者：吴迎春[1] 王俊梅[1] 王哲[1] 孙锐[1] 郝小军[1] 冯冠青[1] WU Ying-chun WANG Jun-mei WANG Zhe SUN Rui HAO Xiao-jun FENG Guan-qing(Departmant of Neurology, the Ordos Central Hospital, Inner Mongolia 017000, China)

机构地区：[1]鄂尔多斯市中心医院神经内科二区,内蒙古017000

出　　处：《脑与神经疾病杂志》2017年第8期497-502,共6页Journal of Brain and Nervous Diseases

摘　　要：目的探讨尿激酶静脉溶栓联合Solitaire AB支架取栓治疗急性前循环大血管闭塞性脑梗死的临床疗效。方法选取鄂尔多斯市中心医院神经内科2015年10月至2016年4月急性脑梗死(ACI)患者8例,进行尿激酶静脉溶栓后采用Solitaire AB取栓装置进行支架取栓术,其中大脑中动脉闭塞4例,颈内动脉和大脑中动脉串联病变2例,颈内动脉末端T型病变2例,分析8例患者的临床特征、影像学资料、治疗及术后3月临床随访结果。以支架取栓后再通率、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及术后3个月随访时改良Rankin量表(mRs)评分评估治疗的有效性;以及手术相关并发症、病死率评估治疗的安全性。结果 8例患者在尿激酶静脉溶栓后行Solitaire AB支架取栓均成功实现血管再通,改良脑梗死溶栓试验(m TICI)分级2b或3级。出院时NIHSS评分中位数6(0,12)分,较术前16.5(12,24)分明显下降(P<0.05),未发生操作相关永久性并发症。6例预后良好(mRS评分为0~2分),1例因梗死后出血残疾(mRS评分为3~4分);1例患者因大面积脑梗死而死亡。结论尿激酶静脉溶栓联合Solitaire AB型支架取栓术治疗急性大脑中动脉和颈内动脉起始段与大脑中动脉串联闭塞(Tandem ICA/MCA,TIM)患者能获得较高的血管再通率,临床预后较好,但对颈内动脉末端闭塞患者效果不理想,死亡率高。Objective To investigate the effect of venous urokinase thrombolysis combined with mechanical thromhectomy device Solitaire AB for the treatment of occlusion of intracranial artery caused acute anterior circulation of cerebral infarction. Method Between October 2015 and April 2016, a total of 8 patients with acute cerebral infarction （ ACI ） underwent thrombectomy by using Solitaire AB stent at Ordos Central Hospital. Simple middle cerebral artery occlusion was seen in 4, 2 of them was accompanied with proximal internal carotid artery occlusion. 2 of them had terminal internal carotid artery occlusion. The clinical features, imaging data, treatment and the results of 3 month clinical follow up were analyzed. The effectiveness of treatment was evaluated through the reeanalization rate after stent thrombectomy, the National Institutes of Health Stroke Scale Scores （ NIHSS ） before and after treatment, the modified Rankin scale （ mrs ） scores, and the 3 month clinical follow up results. The surgery related complications and mortality of patients were used to evaluate the safety of the treatment. Results All of the 8 patients treated by venous urokinase thrombolysis combined with mechanical thrombectomy device Solitaire AB were reeanalized successfully. The modified throbolysis in cerebral infarction （ mTICI ） was 2b or 3. The NIHSSscore median 6 （ 0,12 ）at discharge dropped significantly compared with 16.5 （ 12,24 ）before procedure （ P〈0.05 ）. No permanent complications related to operation occurred. 6 patients had good prognosis （ mRs0-2 ） .One of the recanalized patients had disability （ mRs3-4 ） and the other was died in large area cerebral infarction.Conclusion For the treatment of acute MCA and TIM occlusion, venous urokinase thrombolysis combined with Solitaire AB stent thrombectomy can get higher vascular recanalization rate and clinically safe with satisfactory clinical outcome,although Solitaire AB stent thrombectomy for terminal internal carotid artery occlusion is not

关 键 词：脑梗死 前循环 机械取栓 SolitaireAB支架 尿激酶 静脉溶栓 

分 类 号：R743.34[医药卫生—神经病学与精神病学]