曹惠敏,杨信举,杜 果,肖 松

穿支动脉粥样硬化病（BAD）在亚洲国家较常见，常于发病 48～72 小时内伴神经功能恶化（END），致临床预后差。本研究通过回顾性病例对照研究，分析阿替普酶联合阿加曲班对 BAD 的治疗效果及安全性，为临床治疗提供参考。结果显示，阿替普酶溶栓后联用阿加曲班可降低 END 发生率，改善卒中后 3 个月临床结局，安全性高，具有临床应用价值。

穿支动脉粥样硬化病；神经功能恶化；阿替普酶；阿加曲班

[1] CAPLAN LR. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept[J]. Neurology, 1989, 39(9): 1246-1250. [2] NAKASE T, YOSHIDA T, KATO K, et al. Clinical evaluation of lacunar infarction and branch atheromatous disease[J]. J Stroke Cerebrovasc Dis, 2013, 22(4): 406-412. [3] HE L, ZHANG X, WANG Y, et al. Capsular warning syndrome: clinical analysis and treatment[J]. BMC Neurol, 2019, 19(1): 285. [4] JANG IK, KIM SJ, PARK YS, et al. In vivo thrombin inhibition enhances and sustains arterial recanalization with recombinant tissue-type plasminogen activator[J]. Circ Res, 1990, 67(6): 1552-1561. [5] CHEN L, CAO S, YANG J, et al. Argatroban plus aspirin versus aspirin in acute ischemic stroke[J]. Neurol Res, 2018, 40(10): 862-867. [6] CHEN HS, LIU X, ZHANG Y, et al. Effect of Argatroban Plus Intravenous Alteplase vs Intravenous Alteplase Alone on Neurologic Function in Patients With Acute Ischemic Stroke: The ARAIS Randomized Clinical Trial[J]. Jama, 2023, 329(8):640-650. [7] XU J, WANG Z, LIU Y, et al. Dual Antiplatelet Therapy Plus Argatroban Prevents Early Neurological Deterioration in Branch Atherosclerosis Disease[J]. Stroke, 2022, 53(1): e19-e20. [8] 吴娅,李玮.急性穿支动脉梗死的静脉溶栓治疗现状[J]. 中国卒中杂志，2020, 15(9): 942-946. [9] TAKEDA H, TAKAGI M, YAMAMOTO Y. Branch atheromatous disease: how do we analyze its pathophysiology and treat it to prevent the progression of neurological symptoms?[J]. Rinsho Shinkeigaku, 2010, 50(11): 921-924. [10] 田浩,张昊婕,左靖,等. 穿支动脉粥样硬化病溶栓后早期使用低剂量替罗非班的疗效及安全性研究[J]. 中风与神经疾病杂志，2022, 39(4): 343-346. [11] 吴年宝.阿加曲班联合双抗治疗 72h 内脑梗死的疗效观察及安全性评估[J]. 中国实用神经疾病杂志，2020, 23(5): 406-410. [12] POWERS WJ, RAINEY L, BHAVANI S, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49(3): e46-e110.

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