急性后循环缺血静脉溶栓后桥接颅外段椎动脉支架治疗临床体会  

Clinical experience of acute posterior circulation ischemia treated with IV r-tPA and bridged with extracranial vertebral artery stenting

作　　者：于江华[1] 史志勤 苏旭东[1] 李鑫[1] 陈瑞卿 刘增品[1] 周毅[1] 檀国军[1] 郭力[1] Yu Jianghua;Shi Zhiqin;Su Xudong;Li Xin;Chen Ruiqing;Liu Zengpin;Zhou Yi;Tan Guojun;Gou Li(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,河北省神经病学重点实验室,石家庄050000 [2]河北医科大学实验诊断教研室

出　　处：《脑与神经疾病杂志》2018年第11期672-675,共4页Journal of Brain and Nervous Diseases

基　　金：河北省医学适用技术跟踪项目(GL201618)

摘　　要：目的探讨急性后循环缺血的临床表现,静脉溶栓及桥接急诊支架置入治疗的疗效。方法报道河北医科大学第二医院神经内科收治的1例急性后循环缺血患者,时间窗内静脉溶栓,桥接颅外段椎动脉支架置入的治疗方案及结果。结果本例患者就诊时临床症状主要表现为头晕、言语不清,常规治疗后患者症状突发加重至浅昏迷,复查头颅CT排除出血后给予时间窗内静脉溶栓治疗,随即桥接全脑血管造影并行急诊颅外段椎动脉重度狭窄支架置入治疗。经过控制血压,减轻脑水肿及抗血小板聚集等治疗后,患者临床症状消失。结论大血管狭窄或闭塞导致的急性后循环缺血往往临床症状较重,静脉溶栓治疗目前仍做为首选,桥接血管内支架置入能够解决责任颅外段椎动脉血管的重度狭窄,改善患者临床预后。Objective To explore the clinical manifestations of acute posterior circulation ischemia,and the safety of emergent stent placement bridged with intravenous thrombolysis.Method Introduced the protocol and prognosis of a case of acute posterior circulation ischemia,who was treated intravenous thrombolysis within 4.5h,and bridged by stent implanted extracranial vertebral artery emergently.Results The original symptoms of this case mainly characterized by dizziness and glossolalia,otherwise,the patient suddenly fall into light coma after conventional antithrombotic therapy.Review head CT ruled out intracranial bleeding and then thrombolysis treatment was given through venous within time window.Digital subtract angiography(DSA)was performed and defined the extracranial vertebral artery as criminal artery.Endovascular stenting implantation was implemented subsequently.Through blood pressure control,reduce brain edema,removal of oxygen free radicals,nutrient nerve and antiplatelet treatment,clinical symptoms disappeared in 10 days.Conclusion Acute posterior circulation ischemia tend to be bad outcomes and intravenous thrombolysis therapy is the preferred treatment,bridging with endovascular stent implantation can solve severe extracranial vertebral stenosis,improving clinical prognosis.

关 键 词：急性缺血性卒中 后循环 溶栓 桥接 支架 

分 类 号：R743.32[医药卫生—神经病学与精神病学]