With the aging of our society, the number of patients with cerebrovascular disease is increasing, with about 5.5 million cases nationwide, three-quarters of which are ischemic cerebrovascular disease, i.e., cerebral infarction. The high morbidity, mortality and disability rate of ischemic cerebrovascular disease seriously affect people’s healthy living standard and restrict the rapid development of social economy. For many years, people have been struggling to find the panacea for cerebral infarction. But so far there are still no satisfactory results.
Is there really nothing we can do? No, we are not. Due to the rapid development of neurointerventional radiology technology and the clinical application of digital subtraction angiography (DSA), early DSA arterial catheter thrombolysis for acute cerebral infarction (ACI) has become possible and is currently the most effective method for the treatment of ischemic cerebrovascular disease. This therapy can recanalize the embolized vessels and restore the blood supply to the brain tissue in time, but it must be performed within a certain time window (that is, the length of time after the onset of the disease). Thrombolysis and revascularization after exceeding the effective time window is not beneficial, but rather harmful. According to domestic data, the time window for thrombolysis in internal carotid artery system infarction is generally 6 hours, and that in vertebrobasilar artery system infarction is generally 12~24 hours. Compared with systemic intravenous thrombolysis, DSA arterial catheter thrombolysis is a local contact thrombolysis with small doses of drugs, less bleeding side effects and more significant efficacy. This work has been carried out in hospitals with the conditions in China, but fewer cases can be selected.
Treatment plan I. Selection criteria for ACI cases in the carotid system
1.Age 18～80 years old
2, clinical manifestation of stroke syndrome
3, brain CT excludes hemorrhage and early hypointense changes
4.No severe consciousness impairment such as lethargy or coma
5.Severe limb paralysis (muscle strength 0~3 levels)
6. Thrombolysis is completed within 3-6 hours of onset
7. The patient or his family signed the informed consent for thrombolysis treatment
Exclusion criteria for ACI cases in the carotid system
1. Clinical manifestations have improved significantly
2. Minor neurological deficits
3.History of intracranial hemorrhage, or history of severe cerebral infarction in the past 6 months
4, uncontrolled hypertension, >180mmHg/100mmHg
5, systolic blood pressure <100mmHg, suspected of cerebral infarction due to hemodynamic disorders, such as watershed infarction
6, platelet count <100,000/mm3
7, blood glucose <2.7mmol/L or >22.2mmol/L
8.Stroke attack with seizure
9, Severe cardiac, pulmonary, hepatic and renal insufficiency, malignancy and pregnancy, etc.
10. Known bleeding tendency or bleeding disorders
III. Inclusion criteria for vertebrobasilar ACI cases.
1. Clinical manifestations are consistent with vertebrobasilar artery infarction syndrome
2. DSA/MRA confirmed occlusion or stenosis of vertebrobasilar artery
3. Within 24 hours of onset
4. Brain CT excludes hemorrhage
IV. Exclusion criteria for vertebrobasilar artery ACI cases.
1.Coma lasting more than 4 hours
2, brain CT has shown significant hypointense changes in the cerebellum/brainstem with known hemorrhagic tendency or hemorrhagic disease