Urbach H, Ries F, Ostertun B, Solymosi L
Department of Neuroradiology, University of Würzburg, Germany.
Neuroradiology. 1997 Feb;39(2):105-10. doi: 10.1007/s002340050375.
Local intra-arterial fibrinolysis (LIF) is considered to support spontaneous recanalisation, which does not usually occur fast enough to prevent an infarct. Therefore, LIF may, at least theoretically, be especially useful in occlusions with large thromboembolic masses. We report our experience of LIF with urokinase in 12 patients with combined occlusions of the distal internal carotid, anterior and middle cerebral arteries (carotid "T" occlusions). There were 4 patients who survived with minor neurological deficits (Barthel index > 90), 4 with major deficits (Barthel index 40-55) and 4 patients died: in one of the last group a haematoma developed in a middle cerebral artery infarct. Recanalisation and clinical outcome were parallel in 10 of 12 patients. A patient with excellent leptomeningeal collaterals had a good clinical outcome despite only moderate recanalisation, and the patient with the parenchymal haematoma had good recanalisation. Recanalisation with urokinase in carotid "T" occlusions is often poor, but outcome can be good if treatment starts early, recanalisation succeeds and leptomeningeal collateral supply is good. Our results therefore encourage us, unlike previously reported series, to perform LIF in this type of occlusion.
局部动脉内纤维蛋白溶解术（LIF）被认为有助于支持自发再通，而自发再通通常发生得不够快，无法预防梗死。因此，至少从理论上讲，LIF在伴有大的血栓栓塞块的闭塞中可能特别有用。我们报告了我们对12例颈内动脉远端、大脑前动脉和大脑中动脉联合闭塞（颈动脉“T”形闭塞）患者使用尿激酶进行LIF的经验。有4例患者存活，伴有轻微神经功能缺损（巴氏指数>90），4例有严重缺损（巴氏指数40 - 55），4例患者死亡：在最后一组中的1例患者，大脑中动脉梗死处出现了血肿。12例患者中有10例再通情况与临床结果一致。1例软脑膜侧支循环良好的患者尽管再通程度一般，但临床结果良好，而发生实质内血肿的患者再通情况良好。颈动脉“T”形闭塞使用尿激酶进行再通的情况通常较差，但如果早期开始治疗、再通成功且软脑膜侧支供血良好，结果可能较好。因此，与先前报道的系列不同，我们的结果鼓励我们对这种类型的闭塞进行LIF治疗。
