中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
35期
29-33
,共5页
颈动脉%椎动脉%狭窄,病理性%支架%血管成形术
頸動脈%椎動脈%狹窄,病理性%支架%血管成形術
경동맥%추동맥%협착,병이성%지가%혈관성형술
Carotid arteries%Vertebral artery%Constriction,pathologic%Stents%Angioplasty
目的 探讨弓上颅外段脑动脉狭窄支架成形术的手术方法、临床效果及安全性.方法 对症状性狭窄＞50％,无症状性狭窄＞75％的弓上颅外段脑动脉狭窄患者,根据血管直径选择自膨式或球扩式支架进行治疗.其中颈动脉狭窄85例,椎动脉狭窄37例,锁骨下动脉狭窄6例.结果 128例患者共治疗130支血管,置入 131枚支架,使用栓塞保护装置59例,支架置入技术成功率100.00％.狭窄程度均明显改善,狭窄程度由原来的(87.65±8.70)％下降至(14.28±4.87)％.26例发生一过性血压及心率下降,31例发生持续性低血压及心率下降.1例术中出现同侧大脑中动脉M2段闭塞,经溶栓、碎栓后开通,其余127例术中无血管栓塞并发症.18例围手术期出现过度灌注表现,1例出现脑出血(＜ 10ml).术后患者症状均明显改善,随访6～ 36个月,颈动脉超声检查84例支架内无再狭窄,1例出现无症状性再狭窄(＜50％);37例椎动脉狭窄中3例术后1年再次出现缺血症状,复查数字减影血管造影提示支架内再狭窄,再次行支架成形术,症状消失.结论 只要正确选择适应证及围手术期处理,弓上颅外段脑动脉狭窄支架成形术临床效果好,安全性高.
目的 探討弓上顱外段腦動脈狹窄支架成形術的手術方法、臨床效果及安全性.方法 對癥狀性狹窄＞50％,無癥狀性狹窄＞75％的弓上顱外段腦動脈狹窄患者,根據血管直徑選擇自膨式或毬擴式支架進行治療.其中頸動脈狹窄85例,椎動脈狹窄37例,鎖骨下動脈狹窄6例.結果 128例患者共治療130支血管,置入 131枚支架,使用栓塞保護裝置59例,支架置入技術成功率100.00％.狹窄程度均明顯改善,狹窄程度由原來的(87.65±8.70)％下降至(14.28±4.87)％.26例髮生一過性血壓及心率下降,31例髮生持續性低血壓及心率下降.1例術中齣現同側大腦中動脈M2段閉塞,經溶栓、碎栓後開通,其餘127例術中無血管栓塞併髮癥.18例圍手術期齣現過度灌註錶現,1例齣現腦齣血(＜ 10ml).術後患者癥狀均明顯改善,隨訪6～ 36箇月,頸動脈超聲檢查84例支架內無再狹窄,1例齣現無癥狀性再狹窄(＜50％);37例椎動脈狹窄中3例術後1年再次齣現缺血癥狀,複查數字減影血管造影提示支架內再狹窄,再次行支架成形術,癥狀消失.結論 隻要正確選擇適應證及圍手術期處理,弓上顱外段腦動脈狹窄支架成形術臨床效果好,安全性高.
목적 탐토궁상로외단뇌동맥협착지가성형술적수술방법、림상효과급안전성.방법 대증상성협착＞50％,무증상성협착＞75％적궁상로외단뇌동맥협착환자,근거혈관직경선택자팽식혹구확식지가진행치료.기중경동맥협착85례,추동맥협착37례,쇄골하동맥협착6례.결과 128례환자공치료130지혈관,치입 131매지가,사용전새보호장치59례,지가치입기술성공솔100.00％.협착정도균명현개선,협착정도유원래적(87.65±8.70)％하강지(14.28±4.87)％.26례발생일과성혈압급심솔하강,31례발생지속성저혈압급심솔하강.1례술중출현동측대뇌중동맥M2단폐새,경용전、쇄전후개통,기여127례술중무혈관전새병발증.18례위수술기출현과도관주표현,1례출현뇌출혈(＜ 10ml).술후환자증상균명현개선,수방6～ 36개월,경동맥초성검사84례지가내무재협착,1례출현무증상성재협착(＜50％);37례추동맥협착중3례술후1년재차출현결혈증상,복사수자감영혈관조영제시지가내재협착,재차행지가성형술,증상소실.결론 지요정학선택괄응증급위수술기처리,궁상로외단뇌동맥협착지가성형술림상효과호,안전성고.
Objective To discuss the operative methods,clinical effect and safety of endovascular stenting in treatment of upra-arch extra intracranial artery stenosis.Methods Symptomatic carotid artery stenosis ＞ 50％,or no symptomatic stenosis ＞ 75％ with upra-arch extra intracranial artery stenosis patients were treated by endovascular stenting,of all patients,85 cases with carotid artery stenosis,37 cases with vertebral artery stenosis,6 cases with subclavian artery stenosis.Results One hundred and twenty-eight patients were treated with 130 vessel,used 131 stents,59 patients used vascular protection,the achievement rate of stent implantation was 100.00％.The degree of stenosis were significantly improved,the degree of stenosis from (87.65 ± 8.70)％ to (14.28 ± 4.87)％.Twenty-six patients appeared transient decline in blood pressure and heart rate,31 patients appeared persistent hypotension and decrease in heart rate.One patient (no using of vascular protection) appeared obhteration in ipsilateral middle cerebral artery,the artery was recanalization after thrombolysis treatment.The rest of 127 patients did not appear intraoperative vascular embolization complications.Eighteen patients appeared perioperative perfusion in transition,1 case happened cerebral hemorrhage (＜ 10 ml).Postoperative symptoms were improved significantly.Followed up for 6-36 months,84 patients had not restenosis in stent,1 patient had symptomless restenosis (＜ 50％).In 37 patients with vertebral artery stenosis,3 patients again appeared ischemia symptoms in postoperative 1 year,digital subtraction angiography (DSA) showed restenosis in stent,the patient was again given endovascular stenting,the symptoms disappeared.Conclusion As long as the correct choice of indications and perioperative treatment properly,the endovascular stenting in treatment of upra-arch extra intracranial artery stenosis has good clinical effect and high security.
