静脉重组组织型纤溶酶原激活剂(rt-PA)加/不加血管内治疗在动脉粥样硬化狭窄闭塞性急性缺血性中风中效果不佳。急症颞浅动脉-大脑中动脉(STA-MCA)吻合术在一定程度上对进展性脑卒中有效,但rt-PA治疗后不久STA-MCA吻合术的安全性尚不清楚.我们的目的是阐明静脉rt-PA后24小时内STA-MCA吻合的安全性。
从2005年到2015年,根据日本卒中指南,对225例急性缺血性卒中患者给予rt-PA。在我们的机构。有或没有血管内再通的rt-PA给药后,有五名患者接受了紧急STA-MCA吻合。临床时程,手术并发症,并对患者的预后进行了调查。
患者平均年龄为65.4岁(范围49-77岁);3例患者发生颈内动脉闭塞,2例患者大脑中动脉闭塞。入院时美国国立卫生研究院卒中量表评分中位数为12.4(6-17分),手术发生在静脉rt-PA给药后10.6h(5.3-23.6h)。在标准STA-MCA吻合期间实现止血,没有出血并发症.
在我们连续的案例中,在静脉rt-PA至少5.3h后进行紧急STA-MCA吻合术,安全无出血并发症.
Intravenous recombinant tissue-type plasminogen activator (rt-PA) with/without endovascular treatment is not as effective in atherosclerotic steno-occlusive acute ischemic stroke. Urgent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is effective to some extent in progressing stroke, but the safety of STA-MCA anastomosis soon after rt-PA therapy is unknown. Our aim was to clarify the safety of STA-MCA anastomosis within 24 h after intravenous rt-PA.
From 2005 to 2015, rt-PA was administered to 225 patients presenting with acute ischemic stroke according to the Japanese Stroke Guidelines, in our institution. Five patients underwent urgent STA-MCA anastomosis after rt-PA administration with or without endovascular recanalization. Clinical time course, surgical complications, and patients\' prognosis were investigated.
The average of patient age was 65.4 years (range 49-77 years); three patients had internal carotid artery occlusion, and two patients had middle cerebral artery occlusion. The median National Institutes of Health Stroke Scale score on admission was 12.4 (range 6-17 points) and operation occurred 10.6 h (range 5.3-23.6 h) after intravenous rt-PA administration. Hemostasis was achieved during standard STA-MCA anastomosis, and there were no hemorrhagic complications.
In our consecutive cases, urgent STA-MCA anastomosis after at least 5.3 h after intravenous rt-PA was performed safely without hemorrhagic complications.