Arnold M, Nedeltchev K, Mattle H P, Loher T J, Stepper F, Schroth G, Brekenfeld C, Sturzenegger M, Remonda L
Department of Neurology, University Hospital of Berne, Switzerland.
J Neurol Neurosurg Psychiatry. 2003 Jun;74(6):739-42. doi: 10.1136/jnnp.74.6.739.
To determine the safety, efficacy, and predictors of favourable outcome of intra-arterial thrombolysis in acute stroke attributable to internal carotid "T"occlusion
The authors analysed 24 consecutive patients with T occlusions of the internal carotid artery treated by local intra-arterial thrombolysis using urokinase.
The median baseline National Institutes of Health Stroke Scale was 19. The average time from symptom onset to treatment was 237 minutes. Four patients (16.6%) had a favourable (modified Rankin Scale score (mRS</=2)) and 10 patients (41.7%) a poor outcome (mRS 3 or 4) after three months. Ten patients (41.7%) died. One symptomatic intracerebral haemorrhage (4.2%) occurred. Partial recanalisation of the intracranial internal carotid artery was achieved in 15 (63%), of the middle cerebral artery in four (17%), and of the anterior cerebral artery in eight patients (33%). Complete recanalisation never occurred. Sufficient leptomeningeal collaterals as seen on arteriography (p=0.02) and age <60 years (p=0.012) were the only predictors of favourable clinical outcome.
Acute stroke attributable to carotid T occlusion remains a condition with a generally poor prognosis even when intra-arterial thrombolysis is performed. Favourable outcome was seen only in patients with sufficient leptomeningeal collaterals.
确定颈内动脉“T”形闭塞所致急性卒中动脉内溶栓治疗的安全性、有效性及预后良好的预测因素
作者分析了连续24例采用尿激酶进行局部动脉内溶栓治疗的颈内动脉T形闭塞患者。
基线时美国国立卫生研究院卒中量表评分中位数为19分。症状发作至治疗的平均时间为237分钟。三个月后，4例患者（16.6%）预后良好（改良Rankin量表评分（mRS）≤2），10例患者（41.7%）预后不良（mRS 3或4）。10例患者（41.7%）死亡。发生1例有症状性脑出血（4.2%）。15例（63%）实现了颅内颈内动脉部分再通，4例（17%）实现了大脑中动脉部分再通，8例（33%）实现了大脑前动脉部分再通。未出现完全再通。血管造影显示软脑膜侧支循环充分（p=0.02）和年龄<60岁（p=0.012）是预后良好的唯一预测因素。
即使进行动脉内溶栓治疗，颈内动脉T形闭塞所致急性卒中的预后总体仍较差。仅在软脑膜侧支循环充分的患者中观察到良好的预后。
