静脉rt-PA溶栓联合Solitaire支架取栓治疗急性颅内大动脉闭塞的临床观察

摘要

目的 观察静脉rt-PA溶栓联合Solitaire支架机械取栓治疗急性颅内大动脉闭塞患者的临床效果及安全性.方法 选择2015年1月-2016年8月邢台市第三医院脑血管病治疗中心收治的急性颅内动脉闭塞患者19例作为研究对象,其中大脑中动脉闭塞患者11例,颈内动脉颅内段闭塞4例,基底动脉闭塞4例.观察静脉rt-PA溶栓联合Solitaire支架机械取栓治疗急性颅内大动脉闭塞患者的临床效果及安全性.结果 19例患者完全再通15例(79.0%),部分再通2例(10.5%),未开通2例(10.5%),开通率为89.5%.症状性颅内出血2例(10.5%),死亡2例(10.5%).17例患者术后mTICI靶血流可达2b~3级,术前和术后不同时期美国国立卫生研究院卒中量表(NIHSS)评分和日常生活能力量表(ADL)评分比较差异有统计学意义(F=18.85、35.83,均P=0.00).出院时和3个月后随访mRS评分比较差异无统计学意义(U=1.60,P>0.05).结论 对发病4.5 h内的急性颅内大动脉闭塞患者行静脉溶栓联合Solitaire支架机械取栓治疗安全有效.%Objective To investigate the efficacy and safety of mechanical thrombectomy with Solitaire stent and intra-venous thrombolysis in patients with acute intracranial artery occlusion.Methods The 19 patients with acute stroke (in 4.5h intravenous thrombolysis time window) who were carried out intra-venous thrombolysis and mechanical thrombectomy with Solitaire stent were enrolled from Jan 2015 to Aug 2016. There were 11cases of middle cerebral artery occlusion, 4 cases of internal artery occlusion, 4 cases of basilar artery occlusion. To observe the clinical efficacy and safety of intravenous rt-PA thrombolysis combined with mechanical thrombectomy with Solitaire stent in the treatment of acute intracranial arterial occlusion.Results Occluded large arteries of 19 patients were dredged totally or partially, the recanalization rate or partial recanalization rate of blocked blood vessel was 89.5%, including 15 cases with total recanalization (79.0%), 2 cases with partial recanalization (10.5%). There are two patients cannot be re-canalized. After operation, two cases suffered from cerebral hemorrhage,two patients died. The target blood flow can reached form two to three grade. The ranks of NIHSS and ADL between pre-operation and after operation were discrepant obviously(F=18.85,35.83,P=0.00). The degree of disability score showed no significant difference between leaving and 3 months after departure from the hospital(U=1.60,P>0.05).Conclusion Mechanical thrombectomy with Solitaire stent and intra-venous thrombolysis in patients with acute intracranial large artery occlusion is a safe and an effective therapy with in 4.5h intravenous thrombolysis time window.