CAJ | 학술논문

目的探讨对侧颈动脉闭塞患者颈动脉成形支架置入术(CAS)的有效性及安全性.方法回顾性分析2001年1月至2010年1月治疗的56例对侧颈动脉闭塞、同侧颈动脉狭窄患者的病例特点及CAS的疗效.患者均经数字减影血管造影(DSA)证实为一侧颈动脉闭塞、另一侧颈动脉狭窄,狭窄程度在50%～90%,平均72%±15%.经常规准备后在远端脑保护装置保护下行CAS.结果 56例对侧颈动脉闭塞、同侧颈动脉狭窄患者行CAS的技术成功率100%,术后颈动脉直径狭窄率即术后残余狭窄率为0～30%,平均为13%±8%.患者术后脑缺血症状均获改善,仅1例于术后3 d发生原脑梗死部位的慢性出血(CAS侧),开颅手术后遗留轻微神经功能障碍,无缺血性并发症发生,无死亡病例.患者随访6个月～3年,平均27个月,均无脑缺血症状发作,经颈部血管彩色超声复查47例、DSA复查2例均未发现支架内再狭窄.结论对侧颈动脉闭塞的高危患者的CAS治疗是安全、有效的,严格的病例筛选、经验丰富的医生操作及术后严谨的综合处理均可以降低手术并发症的发生.
목적 탐토대측경동맥폐새환자경동맥성형지가치입술(CAS)적유효성급안전성.방법 회고성분석2001년1월지2010년1월치료적56례대측경동맥폐새、동측경동맥협착환자적병례특점급CAS적료효.환자균경수자감영혈관조영(DSA)증실위일측경동맥폐새、령일측경동맥협착,협착정도재50%～90%,평균72%±15%.경상규준비후재원단뇌보호장치보호하행CAS.결과 56례대측경동맥폐새、동측경동맥협착환자행CAS적기술성공솔100%,술후경동맥직경협착솔즉술후잔여협착솔위0～30%,평균위13%±8%.환자술후뇌결혈증상균획개선,부1례우술후3 d발생원뇌경사부위적만성출혈(CAS측),개로수술후유류경미신경공능장애,무결혈성병발증발생,무사망병례.환자수방6개월～3년,평균27개월,균무뇌결혈증상발작,경경부혈관채색초성복사47례、DSA복사2례균미발현지가내재협착.결론 대측경동맥폐새적고위환자적CAS치료시안전、유효적,엄격적병례사선、경험봉부적의생조작급술후엄근적종합처리균가이강저수술병발증적발생.
Objective To discuss the efficiency and safety of carotid angioplasty stenting (CAS) in patients with contralateral carotid artery occlusion. Methods From January 2001 to January 2010,56 carotid artery stenosis patients with contralateral carotid artery occlusion were performed CAS and the feature and results of these cases were analyzed retrospectively. All the cases were confirmed to be carotid artery stenosis with contralateral carotid artery occlusion by digital subtraction angiography (DSA). The diameter stenosis rate was 72% ± 15%. CAS were performed with distal protection device in 56 cases. Results The technique success rate of CAS were 100% in all the 56 patients with contralateral carotid artery occlusion and postprocedure stenosis rate descended to 13% ± 8%, and the symptoms of cerebral ischemia were all improved. Only 1 case occurred remote hemorrhage in the position of previous cerebral infarction in the side of CAS after the procedure, and recovered with light neurological deficit after the craniotomy to remove the hematoma. No ischemic complications or death occurred. During the following up of 6 months to 3 years, no cerebral ischemic symptoms reoccurred. The rechecking results of color Doppler of 47 cases and DSA of 2 cases showed no restenosis in-stent. Conclusions CAS is safe and effective for the patients with contralateral carotid artery occlusion. Critical election of the case, operation of skilled doctors and scrupulous postprocedure general management can decrease the rate of complication.