Ikushima I, Ohta H, Hirai T, Yokogami K, Miyahara D, Maeda N, Yamashita Y
Department of Radiology, Miyakonojo Medical Association Hospital, Miyakonojo, Japan.
AJNR Am J Neuroradiol. 2007 Mar;28(3):513-7.
The goal of this study was to prospectively assess the feasibility, safety, and efficacy of balloon disruption of the middle cerebral artery (MCA) by using a deflated balloon catheter combined with an intra-arterial thrombolysis for the treatment of acute ischemic stroke.
Seven consecutive patients with clinical findings of acute major-vessel stroke met our criteria and underwent balloon disruption of an MCA thrombus with a deflated balloon catheter. The balloon disruption was performed with a low-profile microballoon catheter. The microballoon was inflated in the distal carotid artery and then deflated and advanced just distal to the occlusion site in the MCA. Thereafter, an intra-arterial thrombolysis of the MCA was applied. The maximum time from the onset of symptoms to the start of treatment and maximum dosage of urokinase was 6 hours and 600,000 U. The outcome was classified as good for a modified Rankin Scale (mRS) score of 0 or 1, moderate for a score of 2 or 3, and poor for a score of 4 or 5.
Complete recanalization was achieved in 5 patients and partial recanalization in 3. Three patients recovered to an mRS score of 0 or 1; 3, to scores of 2 or 3; and 1, to a score of 4. No patients died. There was no major intracerebral hemorrhage.
The penetration of the MCA with a deflated balloon catheter combined with an intra-arterial thrombolysis may be a safe and effective treatment for acute ischemic stroke.
本研究的目的是前瞻性评估使用未充盈球囊导管联合动脉内溶栓对大脑中动脉（MCA）进行球囊破裂术治疗急性缺血性卒中的可行性、安全性和有效性。
7例具有急性大血管卒中临床表现的连续患者符合我们的标准，接受了使用未充盈球囊导管对MCA血栓进行球囊破裂术。球囊破裂术使用的是低轮廓微球囊导管。微球囊在颈内动脉远端充盈，然后放气并推进至MCA闭塞部位的远端。此后，对MCA进行动脉内溶栓。从症状发作到开始治疗的最长时间以及尿激酶的最大剂量分别为6小时和60万单位。结局根据改良Rankin量表（mRS）评分分类为良好（0或1分）、中度（2或3分）和差（4或5分）。
5例患者实现了完全再通，3例部分再通。3例患者恢复至mRS评分为0或1分；3例为2或3分；1例为4分。无患者死亡。无严重脑出血。
使用未充盈球囊导管联合动脉内溶栓对MCA进行穿刺可能是治疗急性缺血性卒中的一种安全有效的方法。
