Maiza D, Theron J, Pelouze G A, Casasco A, Courtheoux P, Derlon J M, Mercier V, Petetin L, Evrard C
Department of Thoracic and Cardiovascular Surgery, Centre Hospitalier, Universitaire de Caen, France.
Ann Vasc Surg. 1988 Jul;2(3):205-14. doi: 10.1016/S0890-5096(07)60002-8.
Sixteen patients underwent local fibrinolytic therapy for thrombosis or embolism of the main trunk or intracranial branches of the internal carotid artery. There were eight cases of complete thrombosis of the internal carotid artery, five proximal stenoses of the internal carotid artery with extensive thrombus, one thrombus of the carotid siphon and two middle cerebral artery emboli. Indications for treatment included transient ischemic attacks in 11 cases, cerebral ischemia after carotid arteriography in two cases, and after surgery for atheromatous lesions of the carotid bifurcation in three cases. The fibrinolytic therapy was initiated during carotid surgery in three cases, where extended thrombosis of the internal carotid artery was discovered, which was inaccessible to a Fogarty catheter. The other 13 cases were treated during arteriography procedures. Lysis of the clot was always obtained. One patient died of hematoma of the frontal lobe. All other patients survived and showed neurologic improvement. The neurologic outcome was dependent on the duration and the degree of initial ischemia. Fibrinolytic therapy appears to be beneficial therapy for certain cases of cerebral ischemia.
16例患者因颈内动脉主干或颅内分支血栓形成或栓塞接受了局部纤溶治疗。其中颈内动脉完全血栓形成8例，颈内动脉近端狭窄伴广泛血栓5例，颈动脉虹吸部血栓1例，大脑中动脉栓塞2例。治疗指征包括11例短暂性脑缺血发作，2例颈动脉造影术后脑缺血，3例颈动脉分叉处动脉粥样硬化病变手术后脑缺血。3例在颈动脉手术过程中开始纤溶治疗，术中发现颈内动脉广泛血栓形成，Fogarty导管无法触及。其他13例在血管造影过程中接受治疗。均成功溶解血栓。1例患者死于额叶血肿。所有其他患者均存活且神经功能有所改善。神经功能转归取决于初始缺血的持续时间和程度。纤溶治疗似乎是某些脑缺血病例的有益治疗方法。
