摘要
目的:探讨颈动脉颅外段狭窄行经皮血管内成形及支架置入术(PTAS)后抗动脉硬化的远期效果。方法:39例颈动脉颅外段狭窄均采用自膨式支架经股动脉入路行PTAS,治疗过程中均使用保护伞,术后在抗血小板聚集治疗基础上长期应用阿托伐他汀及普罗布考,观察临床症状改善情况及PTAS术后再狭窄情况。结果:患者术前平均血管狭窄率为82.02%,术后残余狭窄率为10.13%,较术前明显下降,其中24例脑梗死治疗前神经功能缺损评分为6.38±3.16,治疗后为5.42±2.78,治疗前后比较差异有统计学意义(P<0.01);治疗前认知功能评分为21.79±3.05,治疗后为22.63±2.57,差异亦有统计学意义(P<0.01);15例短暂性脑缺血发作(TIA)未再发作。平均随访21个月,再发脑供血不足3例,TIA 2例,脑梗死1例;6例均存在治疗依从性差、危险因素控制不理想情况,其余患者治疗依从性好,无卒中症状再发,经颅多普勒超声检查示支架部位血管通畅良好,未出现血管再狭窄。结论:PTAS是治疗颈动脉颅外段狭窄微创、有效的方法,术中使用保护伞可提高治疗的安全性,术后联合应用抗血小板聚集药物及阿托伐他汀、普罗布考可能降低远期再狭窄率,提高治疗效果。
Objective： To explore the therapy of PTAS of extracranial segment stenosis of carotid artery and the long-term effectiveness of anti-arteriosclerosis after operation. Methods ：39 patients with extracranial segment stenosis of carotid artery underwent PTAS with self-expand stent and protective umbrella by the approach of femoral artery. All the patients underwent therapy of antiplatelet drug,atorvastatin and probueol after operation. Results：The mean stenosis rate of patients was 82. 02% pre-operation, and 10. 13% post-operation with an obvious decrease. The scores of neurologie impairment and cognitive function of 24 stroke patients were improved： 6. 38 ± 3. 16,5. 42 ± 2. 78, post operation with statistical difference （ P 〈 0. 01 ） and 21.79 v3.05,22. 63 ± 2. 57, post operation with statistical difference（P 〈0. 01 ）and the TIA in 15 stoke patients were controlled. The mean follow-up period was 21 months. Within the period ,there were 6 patients with recurrence of cerebral ischemic symptome（3 were cerebrovaseular insufficiency syndrome,2 were TIA and 1 was cerebral infarction）. After analysis, we found that patients had poor therapy compliance and the risk factor had not been controlled effectively or had obvious dysfunction of immune system. The others had better therapy compliance and no recurrence of stroke symptoms and transcranial doppler sonography confirmed that the artery patency was in good condition. Conclusion：PTAS is an effective therapy to cure extracranial segment stenosis of carotid artery with less-invasive trauma and protective umbrella can increase the safety of the operation and antiplatelet combined with atorvastatin and probucol may have a good long-term effectiveness of therapy.
出处
《临床误诊误治》
2009年第10期7-9,共3页
Clinical Misdiagnosis & Mistherapy
