Bergui Mauro, Stura Guido, Daniele Dino, Cerrato Paolo, Berardino Maurizio, Bradac Gianni Boris
Neuroscience Department, S.G. Battista Hospital, University of Turin, Italy.
Stroke. 2006 Jan;37(1):145-50. doi: 10.1161/01.STR.0000195178.20019.dc. Epub 2005 Dec 8.
To report results of mechanical disruption or retrieval of thrombus as first-line treatment in patients with stroke attributable to occlusion of the basilar artery, in particular regarding efficiency and safety.
In 12 consecutive patients with acute stroke attributable to basilar occlusion, mechanical disruption or thrombus retrieval using various loop-shaped tools was tried before eventually starting local intra-arterial thrombolysis with recombinant tissue plasminogen activator (r-tPA). Main inclusion criteria were: National Institutes of Health Stroke Scale score >8 or Glasgow Coma Scale score <12; onset or worsening of symptoms <8 hours; no hemorrhages or large hypodensities on computed tomography scan; and occlusion of the basilar artery matching clinical symptoms. Efficiency included recanalization, procedure time, and r-tPA dose; safety was defined as rate of procedure-related complications. Outcome was evaluated at 3 months.
Mechanical recanalization was successful in 6 patients. A single brain infarction, possibly attributable to distal embolization, occurred. Three patients had good outcomes. In 5 of 6 remaining patients, the artery was recanalized using r-tPA. A single asymptomatic hemorrhage occurred; 3 patients had good outcomes. Procedure time and r-tPA were significantly less in patients with successful mechanical thrombolysis (43.33 minutes and 13.33 mg versus 112.33 minutes and 55.83 mg, respectively).
Mechanical recanalization was effective in half of the patients and at least as safe as local intra-arterial thrombolysis. It allowed to save r-tPA and time. Although the low success rate remains a limit, the excellent and quick anatomical recanalization obtained after successful procedures makes this approach promising.
报告对因基底动脉闭塞所致中风患者进行血栓机械性破碎或取出作为一线治疗的结果，尤其关注其有效性和安全性。
对12例因基底动脉闭塞导致急性中风的连续患者，在最终开始使用重组组织型纤溶酶原激活剂（r - tPA）进行局部动脉内溶栓之前，尝试使用各种环形工具进行血栓机械性破碎或取出。主要纳入标准为：美国国立卫生研究院卒中量表评分>8或格拉斯哥昏迷量表评分<12；症状发作或加重<8小时；计算机断层扫描无出血或大片低密度影；基底动脉闭塞与临床症状相符。有效性包括再通、手术时间和r - tPA剂量；安全性定义为手术相关并发症发生率。在3个月时评估结局。
6例患者机械再通成功。发生了1例可能归因于远端栓塞的脑梗死。3例患者预后良好。其余6例患者中有5例使用r - tPA使动脉再通。发生了1例无症状性出血；3例患者预后良好。成功进行机械溶栓的患者手术时间和r - tPA用量明显更少（分别为43.33分钟和13.33毫克，而未成功进行机械溶栓的患者分别为112.33分钟和55.83毫克）。
机械再通在半数患者中有效，且至少与局部动脉内溶栓一样安全。它节省了r - tPA和时间。尽管成功率较低仍是一个限制因素，但成功手术后获得的出色且快速的解剖学再通使这种方法具有前景。
