Objective To investigate the efficacy and safety of arterial thrombolysis in combination with angioplasty in the treatment of patients with vertebrobasilar ischemic stroke in 6 hours. Methods Twenty-one patients with acute vertebrobasilar ischemic stroke were collected from April 2006 to February 2012. They were divided into either an intra-arterial thrombolysis group (n = 10) or an intra-arte-rial thrombolysis combined with angioplasty group (n = 11) according to the different treatments. Four of the later group underwent routine balloon angioplasty and stenting, 1 underwent stenting, and 6 underwent balloon dilatation only. Vascular recanalization was determined according to the thrombolysis in myocardial infarction (TIMI) criteria. The National Institutes of Health Stroke Scale (NIHSS) scores were used to evaluate the neurological function before and after treatment. The effectiveness of thrombolysis after 3 months was evaluated according to the modified Rankin scale (mRS). Results ① One patient (10.0% ) had complete recanalization in the intra-arterial thrombolysis group and 6 (54.5% ) had complete recanalization in the intra-arterial thrombolysis combined with angioplasty group. There was significant difference between the 2 groups. ②After treatment, the NIHSS scores of both the intra-arterial thrombolysis group and the intra-arterial thrombolysis combined with angioplasty group were decreased, but there were no significant differences in the NIHSS scores immediately after surgery, 24 hours after surgery and 2 weeks after surgery between the 2 groups. ③There was no significant difference in the mortality and the effectiveness during the follow up period between the 2 groups. ④Five patients who successfully conducted stenting had complete recanalization. No restenosis was observed during the follow-up period after surgery, thrombolysis jointly simple balloon dilatation in 6 patients, only two cases had been re-pass (one case was complete re-canalization) , including 1 patient who was followed 3 months had restenosis. Conclusion With simple arterial thrombolysis can not be recanalizalion of the vertebrobasilar artery system in patients with acute is-chemic stroke, arterial thrombolysis combined with angioplasty may improve recanalization rates; stenting compared with simple balloon dilatation efficacy may be better.%目的 探讨动脉内溶栓联合血管成形术治疗椎-基底动脉系统缺血性卒中6h内患者的疗效及安全性. 方法 收集2006年4月-2012年2月椎-基底动脉系统急性缺血性卒中(发病时间＜6h)患者21例,根据所用治疗方式的不同分为单纯动脉内溶栓组(10例)和动脉内溶栓联合血管成形术组(联合治疗组,11例).联合冶疗组中4例行球囊扩张和支架置入术,1例行支架置入术,6例仅行球囊扩张术.根据急性心肌梗死溶栓标准(TIMI)判定血管冉通情况.采用美国国立卫生院卒中评分(NIHSS)评价治疗前后的神经功能.根据改良Rankin量表(mRS)评估溶栓后3个月的疗效.结果 ①单纯溶栓组6例患者的血管再通,其中1例(10.0％)为完全再通,联合治疗组有7例血管再通,其中6例(54.5％)为完全再通,完全再通率差异有统计学意义,P ＜0.05.②经治疗后,单纯溶栓组和联合治疗组的NIHSS评分均下降,但是两组患者的术后即刻、术后24h和术后2周的NIHSS评分比较,组间差异无统计学意义.③两组均有3例患者死亡.治疗3个月后,存活的患者中,单纯溶栓组疗效良好的有4例,疗效差的有3例;联合治疗组分别为5例和3例.两组比较,病死率及疗效差异无统计学意义.④成功施行支架置入术的5例患者,血管均得到完全再通,术后随访未见冉狭窄.而动脉溶栓联合单纯球囊扩张的6例患者中,仅2例获再通(1例为完全再通),其中1例术后3个月发生再狭窄. 结论 对于行单纯动脉内溶栓血管不能冉通的椎-基底动脉系统急性缺血性卒中患者,联合血管内成形术可提高血管再通率；支架置入术较单纯球囊扩张术疗效可能更佳.
展开▼
