CAJ | 학술논문

目的研究近端血流阻塞式脑保护装置MO.MA系统在颈动脉支架成形术中预防脑血管栓塞的疗效,并评价其安全性及可操作性.方法 2007年10月至2008年7月,23例符合外科治疗指征的颈动脉硬化狭窄患者入选本研究,其中19例(82.6%)患者有神经系统症状.全脑血管造影后在脑保护装置MO.MA系统下行颈动脉球囊扩张及支架成形术,计算术中脑缺血时间,观察术中及术后30 d神经系统事件的发生情况.结果颈动脉造影示,6例(26.1%)颈动脉狭窄50%～70%,17例(73.9%)颈动脉狭窄>70%.所有病例在MO.MA系统保护下颈动脉球囊扩张及支架植入均顺利进行,颈动脉平均阻断时间(5.3±1.2)min.术中及围手术期无死亡及脑卒中发生;2例在颈总动脉球囊阻断时出现短暂意识丧失伴对侧肢体短暂抽搐;2例术后出现心动过缓和低血压,持续时间分别为6 h及1周.9例患者术中颈动脉抽血中可见细小斑块碎片.术后30 d随访有1例TIA发作,1例对侧新发脑卒中,术后30 d累积脑卒中发生率及病死率为4.3%.结论应用近端血流阻断式脑保护装置MO.MA系统在颈动脉支架成形术中预防神经系统事件发生是安全有效的,尤其适合重度及不稳定性斑块的颈动脉硬化狭窄支架成形术治疗.
목적 연구근단혈류조새식뇌보호장치MO.MA계통재경동맥지가성형술중예방뇌혈관전새적료효,병평개기안전성급가조작성.방법 2007년10월지2008년7월,23례부합외과치료지정적경동맥경화협착환자입선본연구,기중19례(82.6%)환자유신경계통증상.전뇌혈관조영후재뇌보호장치MO.MA계통하행경동맥구낭확장급지가성형술,계산술중뇌결혈시간,관찰술중급술후30 d신경계통사건적발생정황.결과 경동맥조영시,6례(26.1%)경동맥협착50%～70%,17례(73.9%)경동맥협착>70%.소유병례재MO.MA계통보호하경동맥구낭확장급지가식입균순리진행,경동맥평균조단시간(5.3±1.2)min.술중급위수술기무사망급뇌졸중발생;2례재경총동맥구낭조단시출현단잠의식상실반대측지체단잠추휵;2례술후출현심동과완화저혈압,지속시간분별위6 h급1주.9례환자술중경동맥추혈중가견세소반괴쇄편.술후30 d수방유1례TIA발작,1례대측신발뇌졸중,술후30 d루적뇌졸중발생솔급병사솔위4.3%.결론 응용근단혈류조단식뇌보호장치MO.MA계통재경동맥지가성형술중예방신경계통사건발생시안전유효적,우기괄합중도급불은정성반괴적경동맥경화협착지가성형술치료.
Objectives To study the efficacy of proximal embolic protection device in preventing intracraniat artery embolization during Carotid artery stenting(CAS)and to evaluate its security and maneuverability.Methods From October 2007 to July 2008,23 patients with carotid artery stenosis who were suitable for surgical therapy according to the standards of NASISET or ACAS were enrolled in this clinical research.Among them 19 patients(82.6%)were symptomatic,6 patients(26.1%)with 50%-70%stcnosis and 17 cages(73.9%)with>70%stenosis.All the patients received carotid angioplasty and stenting under the protection of MO.MA system(one kind of proximal embolic protection device).We recorded the cerebral ischemic time during the procedure and observed neurologic events within 30 days.Results All the procedures were performed successfully,the mean cartiod artery blocking time was (5.3±1.2)min.No death or stroke occurred during perioperative period.Two cages of patients developed transient loss of consciousness combined with contralateral limb convulsion.while the common carotid artery was occluded by balloon.Two cases of patients developed bradycadia,sustained 6 hours and 1 week.Plaque debris in the withdrawal blood from carotid artery were found in 9 cases.At 30-day follow-up after CAS.TIA occurred in 1 case,new contralateral stroke occurred in 1 case.the incidence of 30-day stroke and death rate was 4.3%.Conclusion The application of proximal embolic protection device in CAS procedure for preventing neurologic complications is safe and effective,espicially for Severe stenosis and unstable plaque in carotid artery stenting.