【摘要】 目的探讨急诊动脉内溶栓再通、经皮腔内血管成形支架植入术对于改善急性大脑中动脉闭塞患者神经症状和临床预后的可行性、有效性及安全性。方法选取2010年2月—2013年1月河北医科大学第一医院神经外科收治的行急诊动脉内超选择接触溶栓、中动脉狭窄处支架植入术的急性大脑中动脉闭塞患者13例,患者均在发病6h内接受了急诊动脉内接触溶栓、经皮腔内血管成形支架植入术。溶栓再通支架植入术前、术后7 d、术后90 d利用美国国立卫生研究院卒中量表(NIHSS)评分评价神经功能,利用改良Rankin分级量表(MRS)评分和格拉斯哥预后评分(GOS评分)评价临床疗效,记录手术相关并发症、术后90 d内同侧缺血性卒中发生情况。结果所有患者血管造影显示大脑中动脉M1段完全闭塞并伴有中重度狭窄,导致大脑中动脉狭窄或闭塞的原因是动脉粥样硬化。手术成功率为100%(13/13)。术前、术后7 d、术后90 d中位NIHSS评分分别为15.5、6.0、5.5分。术后90 d 11例(85%)有良好的结果 (MRS评分0~2分,GOS评分4~5分),2例(15%)有严重残疾(MRS评分≥4分)。1例(8%)患者术后伴发颅内出血。13例患者术后90 d内均未再次出现同侧缺血性卒中。结论急诊进行动脉内接触溶栓、经皮腔内血管成形支架植入术是改善急性大脑中动脉闭塞患者神经症状安全、有效的方法,可以改善急性大脑中动脉闭塞患者术后7 d内的神经功能,提高术后90 d内的临床疗效。更多还原

【Abstract】 Objective To investigate the feasibility,safety,and efficacy of emergent arterial thrombolysis with tissue plasminogen activator and stent placement in the treatment of patients with acute middle cerebral artery occlusion.Methods 13 patients with acute middle cerebral artery occlusion who underwent emergent arterial thrombolysis and stent placement in artery stenosis in the Department of Neurosurgery of the First Hospital of Hebei Medical University from February 2010 to January 2013 were selected.All the patients were given emergent arterial thrombolysis and stent placement within 6 h after the onset.Before the arterial thrombolysis and stent placement,7 days and 90 days after it,the neurological function was assessed by using NIHSS,and the clinical efficacy was assessed by modified MRS and GOS.Operation related complications and incidence of 90 d ipsilateral ischemic stroke were recorded.Results All patients’ angiography showed entire occlusion in M1 segment of the middle cerebral artery and it was accompanied by moderate to severe stenosis.The cause of cerebral artery stenosis or occlusion was due to atherosclerosis.The surgical success rate was 100%(13/13).Before surgery,7 days and 90 days after surgery,the median NIHSS score was 15.5,6.0 and 5.5 points.11 cases(85%) had a satisfactory outcome(MRS score of 0 to 2,GOS score 4 to 5),2 cases(15%) had a severe disability(MRS score≥4 points).One case(8%) had postoperative intracranial hemorrhage.13 patients did not have ipsilateral ischemic stroke again within 90 days.Conclusion Emergent arterial thrombolysis with tissue plasminogen activator and stent placement is safe and effective in the treatment of patients with acute middle cerebral artery occlusion,and it can improve the 7-day neurologic outcome and 90-day clinical outcome of the patients with acute middle cerebral artery occlusion.更多还原