摘要
目的探讨应用血管成形支架置入术治疗症状性颅外脑血管狭窄的技术可行性、安全性及治疗效果。方法对经DSA全脑血管造影检查示颅外脑动脉狭窄的10例患者(共13处狭窄血管)行血管成形支架置入术,观察其技术成功率、临床效果及并发症发生情况。结果 (1)支架置入情况:共置入支架13枚,均一次性完成支架放置,技术成功率100%,即刻造影显示残余狭窄率<20%者12处、25%～30%者1处,颅内血管造影显示脑实质血流灌注明显改善。(2)临床效果:术后随访20天至18个月,5例脑梗死患者NIHSS评分由术前的平均2.2分降至术后的平均0.8分,临床症状明显改善;3例TIA患者中的2例随访期未再次发作,另1例术后5个月出现非支架侧血管卒中;1例锁骨下动脉盗血患者未再出现盗血现象,1例后循环缺血患者临床症状明显缓解。(3)并发症发生情况:出现近期症状性并发症2例,系术中出现、术后持续的颈动脉窦反射导致的心率下降,均为一过性,最长持续时间<48h;未发现远期支架相关并发症。结论经皮穿刺血管成形支架置入术治疗颅外脑血管狭窄手术成功率高、安全、临床效果好,适合在有条件的医院开展。
Objective To evaluate technical feasibility, safety and therapeutic effect of angioplasty stenting for patients with symptomatic stenosis of extraeranial cerebrovaseular. Methods 10 cases with extracranial cerebral artery stenosis by DSA were included in this study. A total of 13 narrow blood vessels were underwent angioplasty stenting. The success rate of operation, complication and short-medium term effect were observed. Results （1）The situation of stent implanted：13 stents were implanted, and all be underwent successfully in the first time. The success rate of operation was 100%. Postoperative residual stenosis was less than 20% in 12 cases, and ranged from 25 to 30% in I case. Intracranial angiography showed the blood perfusions of the brains were significantly improved. （2）Clinical effect： All cases were followed up 20 days to 18 months after operation. The symptoms were improved obviously in 5 cases with isehemic stroke, with NIHSS score （mean） of 2.2 points before surgery,0. 8 after surgery. Two of the three cases with TIA were not re-attack. The other one case with TIA had antiplatelet ischemic stroke at followed-up 5 months. The symptom of one case with subclavian steal was improved,blood steal phenomenon did not occur again after operation. Symptoms of one case with posterior circulation ischemia were improved. （3）Complications： Early complications occurred in 2 cases, who present decreased heart rate due to persistent postoperative carotid sinus reflex,which is transient,with the longest duration less than 48 hours. The long term stent-related complications were not found. Conclusions Percutaneous angioplasty stenting had benefits including minimal invasion, effect, handling multiple lesions and fewer complications. Percutaneous angioplasty stenting could be performed in some qualified hospitals.
出处
《中国冶金工业医学杂志》
2011年第6期646-648,共3页
Chinese Medical Journal of Metallurgical industry
