尿激酶动脉溶栓联合支架置入术与单纯尿激酶动脉溶栓治疗缺血性卒中的比较

摘要

目的 比较尿激酶动脉溶栓+支架置入术与单纯尿激酶动脉溶栓治疗缺血性卒中的安全性和有效性.方法 回顾性分析64例急性颈内动脉系统脑梗死患者.其中,单纯动脉溶栓组(仅采用尿激酶动脉溶栓)38例,支架置入组(在尿激酶动脉溶栓基础上行支架置入)26例.收集两组病例的医疗和神经影像学资料,比较血管再通率、有症状颅内出血和(或)死亡发生率.采用3个月时改良Rankin量表(modified Rankin Scale,mRS)评分评价两组病例的临床转归.结果 64例缺血性卒中患者中,55例(85.9%)存在血管闭塞,9例(14.0%)存在血管严重狭窄.支架置入组血管再通率为88.5%(23/26),显著高于单纯动脉溶栓组的47.4%(18/38)(χ2=16.6,P=0.00).与单纯动脉溶栓组相比,支架置入组3个月时mRS评分＜2分的患者比例显著增高(47.4%对73.1%,χ2=4.18,P=0.04),有症状颅内出血或死亡发生率无显著差异(7.8%对7.7,χ2=0.00,P=0.97).结论 对闭塞和重度狭窄动脉行尿激酶动脉溶栓联合支架置入术治疗急性缺血性卒中患者的血管再通率高于单纯尿激酶动脉溶栓,且远期转归更好.%Objective To compare the safety and efficacy of intra-arterial urokinase thrombolysis alone and intra-arterial urokinase thrombolysis + stenting for ischemic stroke. Methods Sixty-four patients with acute cerebral infarction in the internal carotid artery system were analyzed retrospectively. The patients were divided into intra-arterial thrombolysis group (n = 38; using urokinase only) and stenting group (n = 26; using urokinase + stenting). The medical and imaging data of the patients in both groups were collected. The revascularization rate, and symptomatic intracranial hemorrhage and/or mortality rates were compared. The modified Rankin Scale (mRS) scores at 3 months were used to evaluate the clinical outcome in both groups. Results Of the 64 patients with ischemic stroke, 55 (85. 9%) had vascular occlusion, 9 (14. 0% ) had severe arterial stenosis. The revascularization rate in the thromborysis group was 47.4% (18/38), and that in the stenting group was 88.5% (23/26). Compared to the drug thrombolysis group, the proportion of patients whose mRS scores ＜2 at 3 months after procedure (47. 4% vs. 73. 1%,χ2 = 4. 18,P = 0. 00). There was no significant difference between the symptomatic intracranial hemorrhage rate and death rate (7. 8% vs. 7.7% , χ2 = 0.00, P =0. 62). Conclusions When patients with acute ischemic stroke are treated with ultra-early endovascular treatment, the revascularization rate of the occlusion and severe artery stenosis treated with mechanical recanalization + stenting was significantly higher than that of the simple intra-arterial thrombolytic drug, and the long-term clinical outcome is better.