Conservative treatment of carotid artery occlusion

Carotid artery occlusion is a relatively common neck problem and a disease that has a great impact on human health. If it is not treated in time, it may even cause people's heads to be unable to turn freely and threaten their lives. There are many treatments for carotid artery occlusion, such as intra-arterial thrombolysis, brain protection therapy, anticoagulation therapy, fibrinolytic therapy, antiplatelet therapy, etc.

1. Arterial thrombolysis therapy

As an emergency treatment for stroke, superselective interventional arterial thrombolysis can be performed under direct DSA visualization. Urokinase arterial thrombolysis combined with low-dose heparin intravenous infusion may be beneficial for patients with stroke in the middle cerebral artery distribution area who have symptoms for 3-6 hours.

2. Brain protection therapy

A variety of brain protective agents have been suggested for use. When taken before the initiation of the ischemic cascade, they can reduce ischemic brain damage by reducing brain metabolism and intervening in the cytotoxic mechanism induced by ischemia. Including free radical scavengers (superoxide dismutase, barbiturates, vitamin E and vitamin C, 21-aminosteroids, etc.), as well as opioid receptor blockers naloxone, voltage-gated calcium channel blockers, excitatory amino acid receptor blockers and metronidazole ions. Currently, early (<2h) application of head or whole-body hypothermia treatment is recommended. Drugs can include citicoline, the new free radical scavenger edaravone, early (<4h) 10% protein albumin, cyclophosphamide and colchicine combined. However, many brain protective agents are effective in animal experiments, but have poor or ineffective clinical efficacy, and sufficient evidence is still needed.

3. Anticoagulant therapy

It has not been shown to be effective in most cases of complete stroke and does not appear to affect the course of an established stroke. It can be used in a short term to prevent thrombus expansion, progressive stroke, and re-occlusion after thrombolytic therapy. Commonly used drugs include heparin, low molecular weight heparin and warfarin. During treatment, the coagulation time and prothrombin time should be tested, and inhibitors such as vitamin K and protamine sulfate should be available to deal with possible bleeding complications.

4. Fibrosis-reducing treatment

It inhibits thrombosis by degrading fibrinogen and enhancing the activity of the fibrinolytic system. The available drugs include batroxobin, defibrase, ancrolein and lumbrokinase. The first dose of batroxobin is 1.BU, followed by 5BU every other day, intravenously for a total of 3-4 times, with good safety.

5. Antiplatelet therapy

Large-scale, multicenter randomized controlled clinical trials have shown that the use of aspirin 100-300 mg/d within 48 hours of onset in unselected patients with acute cerebral infarction can reduce mortality and recurrence rates, and its use is recommended. However, thrombolytic or anticoagulant therapy should not be used simultaneously as it may increase the risk of bleeding. Antiplatelet agents such as ticlopidine and clopidogrel can also be used.