Comerota A J, Eze A R
Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
J Vasc Surg. 1996 Dec;24(6):1008-16. doi: 10.1016/s0741-5214(96)70046-0.
Operative stroke complicating carotid endarterectomy is traditionally treated by reexploration of the operative site to correct a potentially causative lesion; however, attempts are not made to diagnose or treat the intracranial arterial occlusion. A 65-year-old man had a right hemiplegia during a left carotid endarterectomy that was caused by premature reversal of heparin, which resulted in thrombosis of his left anterior cerebral artery. On reexploration, the patient was treated with a 1-hour infusion of 1 million U urokinase through an indwelling carotid shunt. A repeat arteriogram demonstrated patency of the left anterior cerebral artery, with complete clot dissolution and resolution of the right hemiplegia on awakening. Natural history studies of stroke and prospective, angiographically controlled clinical trials of intraarterial thrombolytic therapy for acute stroke support the use of intraoperative intraarterial infusion of urokinase as part of a therapeutic approach to patients who have an ischemic stroke during carotid endarterectomy.
传统上，颈动脉内膜切除术并发的手术性中风是通过再次探查手术部位以纠正潜在的致病病变来治疗的；然而，并不尝试诊断或治疗颅内动脉闭塞。一名65岁男性在左颈动脉内膜切除术中出现右侧偏瘫，原因是肝素过早逆转，导致其左大脑前动脉血栓形成。再次探查时，通过留置的颈动脉分流管给患者输注100万单位尿激酶1小时进行治疗。重复血管造影显示左大脑前动脉通畅，血栓完全溶解，苏醒后右侧偏瘫消失。中风的自然史研究以及针对急性中风的动脉内溶栓治疗的前瞻性、血管造影对照临床试验支持在颈动脉内膜切除术期间，将术中动脉内输注尿激酶作为对缺血性中风患者的一种治疗方法的一部分。
