Yun J S, Kwak Hyo Sung, Hwang S B, Chung G H
Radiology Department, Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Korea.
Interv Neuroradiol. 2011 Dec;17(4):435-41. doi: 10.1177/159101991101700407. Epub 2011 Dec 16.
Mechanical clot disruption for the treatment of acute basilar artery occlusion (BAO) is known to provide a benefit. We aimed to determine the safety, recanalization rate and time-to-flow restoration of mechanical clot disruption and low dose urokinase (UK) infusions for the treatment of patients with acute BAO. Between June 2006 and June 2010, 21 patients with acute BAO underwent endovascular treatment that included angioplasty or stent placement. The time to treatment, duration of the procedure, dose of urokinase (UK), recanalization rates and symptomatic hemorrhages were analyzed. Clinical outcome measures were assessed at admission and at the time of discharge using the National Institutes of Health Stroke Scale (NIHSS) score and at three months after treatment using the modified Rankin Score (mRS). On admission, the median NIHSS score was 13.2. Median time from symptom onset to arrival at hospital was 356 minutes, and median time from symptom onset to intraarterial thrombolysis (IAT) was 49 minutes. We used the following interventional treatment regimens: Intra-arterial (IA) UK and a minimal mechanical procedure (n=14), IA UK with angioplasty (n=1), IA UK with angioplasty and stent placement (n=3) and IA UK with HyperForm (n=3). The recanalization (thrombolysis in cerebral ischemia grade II or III) rate was 90.5% (19/21). There was symptomatic hemorrhage in one patient (4.8%). The median NIHSS score at discharge was 6.3. The three-month outcome was favorable (mRS: 0-2) for 14 patients (66.7%) and poor (mRS: 3-6) for seven patients (33.3%). The overall mortality at three months was 14.3% (three patients died). Low-dose IAT with mechanical clot disruption is a safe and effective treatment for treatment for acute BAO.
机械性血栓破碎术用于治疗急性基底动脉闭塞（BAO）已被证实有益。我们旨在确定机械性血栓破碎术联合低剂量尿激酶（UK）输注治疗急性BAO患者的安全性、再通率及血流恢复时间。2006年6月至2010年6月期间，21例急性BAO患者接受了包括血管成形术或支架置入术在内的血管内治疗。分析了治疗时间、手术持续时间、尿激酶（UK）剂量、再通率及症状性出血情况。使用美国国立卫生研究院卒中量表（NIHSS）评分在入院时和出院时评估临床结局指标，并在治疗后三个月使用改良Rankin量表（mRS）进行评估。入院时，NIHSS评分中位数为13.2。症状发作至入院的中位时间为356分钟，症状发作至动脉内溶栓（IAT）的中位时间为49分钟。我们采用了以下介入治疗方案：动脉内（IA）UK联合最小限度机械操作（n = 14）、IA UK联合血管成形术（n = 1）、IA UK联合血管成形术及支架置入术（n = 3）以及IA UK联合HyperForm（n = 3）。再通率（脑缺血溶栓分级II级或III级）为90.5%（19/21）。1例患者出现症状性出血（4.8%）。出院时NIHSS评分中位数为6.3。14例患者（66.7%）三个月结局良好（mRS：0 - 2），7例患者（33.3%）结局较差（mRS：3 - 6）。三个月时的总死亡率为14.3%（3例患者死亡）。低剂量IAT联合机械性血栓破碎术是治疗急性BAO的一种安全有效的方法。
