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目的:评价超选择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。方法:对6例合并动脉狭窄的急性脑梗死病人,其中颈内动脉闭塞3例、大脑中动脉闭塞2例、椎动脉闭塞1例。将微导管超选择送至血管闭塞部位,注入艾通立(重组组织型纤溶酶原激活剂,r-TPA)行动脉溶栓,然后对明显的残余血管狭窄,采用血管内支架成形术治疗。结果:治疗前临床神经功能缺损评分犤1犦(europeanstrokescale,ESS):53.60±13.25;治疗后7dESS评分:91.65±15.36。6例有明显的血管狭窄者全部狭窄均在75%～99%之间,术后全部血流通畅,脑血流量恢复。支架定位准确,血管残余狭窄<14%。结论:早期超选择动脉内接触性溶栓结合支架血管内成形术是治疗合并动脉狭窄的急性脑梗死患者的最有效的方法之一。
Objective: To evaluate the clinical effect of superselective arterial thrombolysis combined with endovascular stenting in the treatment of acute cerebral infarction complicated by arterial stenosis. Methods: Six patients with acute cerebral infarction complicated by arterial stenosis, including 3 cases of occlusion of internal carotid artery, 2 cases of middle cerebral artery occlusion and 1 case of vertebral artery occlusion. The microcatheter was superselectively delivered to the site of vascular occlusion and injected with angiotensin (recombinant tissue-type plasminogen activator, r-TPA) for arterial thrombolysis followed by significant stent stenosis by endovascular stenting . Results: Before treatment, the score of clinical neurological deficit (ESS) was 53.60 ± 13.25. After 7 days of treatment, the score of DES was 91.65 ± 15.36.6 The stenosis of all the patients with obvious vascular stenosis was between 75% -99% , All the blood flow was smooth and the blood flow of the brain recovered. Stent accurate positioning, residual vascular stenosis <14%. CONCLUSIONS: Early superselective intra-arterial contact thrombolysis and stent angioplasty is one of the most effective methods for the treatment of patients with acute cerebral infarction complicated by arterial stenosis.