Cronqvist M, Pierot L, Boulin A, Cognard C, Castaings L, Moret J
Department of Neuroradiology, University Hospital, Lund, Sweden.
AJNR Am J Neuroradiol. 1998 Jan;19(1):157-65.
We describe our therapeutic strategy and correlate the anatomic results and clinical outcomes in patients who received immediate fibrinolytic therapy for thromboembolic complications occurring during endovascular treatment of an intracerebral aneurysm.
The medical records and angiographic examinations of 19 patients were reviewed. All endovascular procedures were performed with the patients under general anesthesia and fully heparinized. Thirteen patients received an intravenous bolus injection of aspirin. Thromboemboli occurred during catheterization or insertion of embolic material (Guglielmi detachable coils or mechanical detachable spirals) or in the first hours after the intervention. Clot distribution was within the MCA territory in 14 patients, the ACA in three patients, and the basilar trunk in two patients. A continuous intraarterial injection of urokinase was administered immediately, either superselectively distal to the thrombus or selectively within or closely proximal to the thrombus. In nine cases, chemical lysis was combined with mechanical clot fragmentation. Initial anatomic recanalization as well as clinical outcome at 3 months were evaluated.
Ten patients showed complete recanalization and nine patients showed partial recanalization. Fourteen patients had a good clinical recovery. One patient was moderately disabled and two were severely disabled according to their scores on the Glasgow outcome scale. Two patients died, one as a consequence of the preexisting subarachnoid hemorrhage and the other because of a large intracerebral hematoma that developed after fibrinolysis. Of the 14 patients with a good clinical outcome, nine exhibited complete recanalization and five partial recanalization.
Pharmacological thrombolysis seems to be a safe and efficient therapy that facilitates the natural fibrinolytic process, increasing the rate of recanalization in thromboembolic events. Clot fragmentation and superselective drug infusion appear to improve the rate of recanalization. Complete recanalization increases the chance of a better clinical outcome; however, clinical outcome does not always correspond to recanalization and vice versa.
我们描述了针对脑内动脉瘤血管内治疗期间发生的血栓栓塞并发症接受即时纤溶治疗的患者的治疗策略，并将解剖学结果与临床结局进行关联。
回顾了19例患者的病历和血管造影检查。所有血管内手术均在全身麻醉且充分肝素化的患者身上进行。13例患者接受了阿司匹林静脉推注。血栓栓塞发生在导管插入或栓塞材料（ Guglielmi 可脱性弹簧圈或机械可脱性螺旋圈）插入期间或干预后的最初数小时内。14例患者的血栓分布在大脑中动脉区域，3例在大脑前动脉，2例在基底动脉干。立即进行尿激酶持续动脉内注射，要么在血栓远端超选择性注射，要么在血栓内或血栓近端附近选择性注射。9例患者中，化学溶栓与机械碎栓相结合。评估了初始解剖再通情况以及3个月时的临床结局。
10例患者显示完全再通，9例患者显示部分再通。14例患者临床恢复良好。根据格拉斯哥预后量表评分，1例患者中度残疾，2例严重残疾。2例患者死亡，1例死于先前存在的蛛网膜下腔出血，另1例死于溶栓后形成的巨大脑内血肿。在14例临床结局良好的患者中，9例显示完全再通，5例部分再通。
药物溶栓似乎是一种安全有效的治疗方法，可促进自然纤溶过程，提高血栓栓塞事件中的再通率。碎栓和超选择性药物输注似乎可提高再通率。完全再通增加了获得更好临床结局的机会；然而，临床结局并不总是与再通情况相符，反之亦然。
