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目的观察颈内动脉(ICA)、大脑中动脉(MCA)和椎-基底动脉(VBA)闭塞致急性脑梗死患者不同时间窗动脉溶栓治疗的疗效。方法分别对19例发病<6h及21例发病6～9h不同血管(ICA12例,MCA18例,VBA10例)闭塞患者,根据头颅磁共振灌注加权成像(PWI)/弥散加权成像(DWI)≥20%的急性脑梗死患者行动脉内超选择性重组组织型纤溶酶原激活物(r-tPA)溶栓治疗。治疗前后进行卒中量表(NIH-SS)评分,治疗后90d用修正Rankin量表(MRS)评价临床预后。结果溶栓后血管再通率:MCA组77.8%,VBA组50.0%,ICA组33.3%,3组间差异有统计学意义(均P<0.05)。发病<6h组和6～9h组患者溶栓治疗后NIHSS评分比治疗前明显改善(均P<0.05),两组间NIHSS的改善程度差异无统计学意义(P>0.05)。治疗后90d时预后良好率:MCA组77.8%,ICA组41.7%,VBA组30.0%,3组间差异有统计学意义(均P<0.05)。术后发生颅内出血4例,血管再闭塞1例。结论动脉溶栓治疗MCA闭塞的疗效最好,ICA闭塞次之,VBA闭塞较差。动脉溶栓时间窗<6h与6～9h的疗效无明显差异。提示对PWI/DWI不匹配的患者,动脉溶栓治疗时间窗可放宽到9h。
Objective To observe the curative effect of window thrombolysis in patients with acute cerebral infarction caused by occlusion of internal carotid artery (ICA), middle cerebral artery (MCA) and vertebrobasilar artery (VBA). Methods Nineteen patients with occlusive disease of less than 6% and 21 cases of 6 ~ 9 hours with different blood vessels (ICA 12, MCA 18, VBA 10) were divided into two groups according to the following parameters: head magnetic resonance perfusion weighted imaging (PWI) Of patients with acute cerebral infarction underwent intra-arterial superselective recombinant tissue-type plasminogen activator (r-tPA) thrombolysis. The Stroke Scale (NIH-SS) was scored before and after treatment, and the clinical outcome was evaluated by Modified Rankin Scale (MRS) 90 days after treatment. Results The rate of recanalization after thrombolysis was 77.8% in MCA group, 50.0% in VBA group and 33.3% in ICA group. There was significant difference between the three groups (all P <0.05). NIHSS scores of patients with onset <6h and 6 ~ 9h after thrombolysis were significantly improved than before treatment (all P <0.05). There was no significant difference in the improvement of NIHSS between the two groups (P> 0.05). The good prognosis at 90 days after treatment was 77.8% in MCA group, 41.7% in ICA group and 30.0% in VBA group. There was significant difference among the three groups (all P <0.05). Postoperative intracranial hemorrhage in 4 cases, vascular reoperation in 1 case. Conclusion Arterial thrombolysis has the best curative effect on MCA occlusion, followed by ICA occlusion and VBA occlusion. Arterial thrombolysis time window <6h and 6 ~ 9h no significant difference in the efficacy. Prompt PWI / DWI mismatch patients, arterial thrombolytic treatment time window can be relaxed to 9h.