中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
27期
2139-2142
,共4页
阳清伟%吉训明%李慎茂%朱凤水%谌燕飞%叶明%焦力群
暘清偉%吉訓明%李慎茂%硃鳳水%諶燕飛%葉明%焦力群
양청위%길훈명%리신무%주봉수%심연비%협명%초력군
颈动脉狭窄%动脉闭塞性疾病%支架%栓塞保护装置
頸動脈狹窄%動脈閉塞性疾病%支架%栓塞保護裝置
경동맥협착%동맥폐새성질병%지가%전새보호장치
Carotid stenosis%Arterial occlusive diseases%Stents%Embolic protection devices
目的 通过回顾颈内动脉(ICA)次全闭塞的支架成形术及其围手术期情况,总结分析该手术的安全性和有效性,并比较近端球囊保护装置与远端过滤保护装置在栓子保护方面的优劣.方法 回顾北京宣武医院2006-2012年所有颈内动脉次全闭塞患者的支架成形术,通过头颅MRI中DWI序列判断是否术后有无新发脑梗死,并计算每例患者新发脑梗死的病灶数量.结果 共有35例颈内动脉次全闭塞的患者接受了支架手术,其中21例患者使用近端保护装置,14例使用远端过滤保护装置.32例患者术前及术后48 d内行头颅MRI,近端球囊保护装置组的脑梗死发生率较远端过滤保护装置组低(6/18比10/14,P=0.03),脑梗死病灶数量也较远端过滤保护装置组少(1/18比4/14,P=0.0006).所有患者术后3个月随访内未发生严重心脑血管事件,30例患者临床症状得到改善,3例患者颈动脉彩超显示支架术后发生再狭窄.结论 症状性的颈内动脉次全闭塞的患者可考虑颈内动脉支架成形术,此手术采用近端球囊保护装置较远端过滤保护装置可能更有效的预防脑栓塞.颈内动脉次全闭塞的支架成形术仍有待大样本的临床随机对照研究进一步证实.
目的 通過迴顧頸內動脈(ICA)次全閉塞的支架成形術及其圍手術期情況,總結分析該手術的安全性和有效性,併比較近耑毬囊保護裝置與遠耑過濾保護裝置在栓子保護方麵的優劣.方法 迴顧北京宣武醫院2006-2012年所有頸內動脈次全閉塞患者的支架成形術,通過頭顱MRI中DWI序列判斷是否術後有無新髮腦梗死,併計算每例患者新髮腦梗死的病竈數量.結果 共有35例頸內動脈次全閉塞的患者接受瞭支架手術,其中21例患者使用近耑保護裝置,14例使用遠耑過濾保護裝置.32例患者術前及術後48 d內行頭顱MRI,近耑毬囊保護裝置組的腦梗死髮生率較遠耑過濾保護裝置組低(6/18比10/14,P=0.03),腦梗死病竈數量也較遠耑過濾保護裝置組少(1/18比4/14,P=0.0006).所有患者術後3箇月隨訪內未髮生嚴重心腦血管事件,30例患者臨床癥狀得到改善,3例患者頸動脈綵超顯示支架術後髮生再狹窄.結論 癥狀性的頸內動脈次全閉塞的患者可攷慮頸內動脈支架成形術,此手術採用近耑毬囊保護裝置較遠耑過濾保護裝置可能更有效的預防腦栓塞.頸內動脈次全閉塞的支架成形術仍有待大樣本的臨床隨機對照研究進一步證實.
목적 통과회고경내동맥(ICA)차전폐새적지가성형술급기위수술기정황,총결분석해수술적안전성화유효성,병비교근단구낭보호장치여원단과려보호장치재전자보호방면적우렬.방법 회고북경선무의원2006-2012년소유경내동맥차전폐새환자적지가성형술,통과두로MRI중DWI서렬판단시부술후유무신발뇌경사,병계산매례환자신발뇌경사적병조수량.결과 공유35례경내동맥차전폐새적환자접수료지가수술,기중21례환자사용근단보호장치,14례사용원단과려보호장치.32례환자술전급술후48 d내행두로MRI,근단구낭보호장치조적뇌경사발생솔교원단과려보호장치조저(6/18비10/14,P=0.03),뇌경사병조수량야교원단과려보호장치조소(1/18비4/14,P=0.0006).소유환자술후3개월수방내미발생엄중심뇌혈관사건,30례환자림상증상득도개선,3례환자경동맥채초현시지가술후발생재협착.결론 증상성적경내동맥차전폐새적환자가고필경내동맥지가성형술,차수술채용근단구낭보호장치교원단과려보호장치가능경유효적예방뇌전새.경내동맥차전폐새적지가성형술잉유대대양본적림상수궤대조연구진일보증실.
Objective To study the safety,efficacy and perioperative complications of endovascular therapy in the treatment of subtotal conclusion of internal carotid artery(ICA) in patients.To compare the cerebral embolic load of proximal balloon protection device versus distal filter protection device during the operation.Methods Review all the operations of stenting for subtotal conclusion of ICA in Xuanwu hospital.New cerebral infarction after stenting was assessed by diffusion-weighted magnetic resonance imaging.Count the number of new ischemic lesions of every patient.Results 35 patients with subtotal conclusion of ICA received endovascular stenting.Proximal protective device was used for 21 patients.Distal protective device was used for 14 patients.All procedures succeeded.32 patients received the cerebral MRI 1 week before and within 48 hours after the operation.Compared with filter protection(n =14),proximal balloon device (n =18) resulted in a significant reduction in the incidence of new cerebral infarction (6/18 vs 10/14,P =0.03).The number of new cerebral ischemic lesions were significant reduced by proximal balloon device(1/18 vs 4/14,P =0.0006).There were no serious cardiovascular events in 35 patients during the operation and the following up 3 months.3 patients had restenosis which was denonstrated by ultrasound of ICA at 3 months after stenting.Conclusions Endovascular stenting may be a safe and valid method for the treatment of subtotal occlusion of ICA.For the stenting of subtotal occlusion of ICA,proximal ballon protection device as compared with filter protection may reduce the embolic load to the brain more effectively.The stenting of subtotal occlusion of ICA still needs the randomized trails to confirm the safety and validity.
