摘要
目的探讨颈内动脉狭窄支架成形术的适应证、手术方法、临床效果、安全性以及围手术期并发症的防治方法。方法选择2013年1月至2014年6月在我科颈动脉狭窄住院患者,其中20例颈内动脉颅外段狭窄达到支架成形术指征(症状性颈内动脉狭窄>50%,无症状性狭窄>75%)的患者作为治疗组,给予支架成形术,同时选择20例颈内动脉狭窄虽然到达支架成形术指征,但不愿意接受支架成形术单纯采用保守治疗(控制危险因素+降脂、降压、控制血糖等药物对症治疗)的患者作为对照组。治疗组除给予支架成形术外,同时控制危险因素,降脂、降压、控制血糖药物等对症治疗。手术前后对两组进行颈部血管彩色超声、经颅多普勒超声(TCD)、磁共振血管造影(MRA)、CT灌注(CTP)、数字减影血管造影(DSA)等检查,同时进行美国国立卫生研究院卒中量表(NIHSS)评分和日常生活能力(ADL)评分、6个月内再发卒中的调查等,对有关结果进行统计学分析。结果治疗组支架置入术成功率100%。颈动脉支架成形术后3周测量狭窄程度由原来的(87.65±7.63)%下降至(12.58±4.83)%(P<0.01)。5例发生短暂性血压及心率下降,8例发生持续性低血压及心率下降。6例围手术期出现过度灌注表现,无脑出血等严重并发症;治疗组手术前后脑血流量(CBF)、脑血容量(CBV)明显改善(P<0.05);治疗组随访6个月,术后无支架内再狭窄;治疗组ADL评分、NIHSS评分均优于对照组(P<0.05);治疗组在6个月内无再发卒中,而对照组有4例发生卒中(P<0.05),差异有统计学意义(P<0.01)。结论颈动脉狭窄支架成形术临床效果好,术后支架内再发狭窄率低,能够明显改善患者生活质量及预防再发卒中,明显优于内科药物保守治疗。
Objective To explore the indications, surgical methods, clinical effect, safety of stent angioplasty of the internal carotid artery stenosis and the prevention methods of perioperative complications. Methods Twenty patients with stenting testify of extracranial stenosis of internal carotid artery from January 2013 to June 2014 in our department were selected as the treatment group（symptomatic stenosis of internal carotid artery 〉 50%, asymptomatic stenosis 〉 75% ）, who were given the stent angioplasty. While the control group included 20 patients whose stenosis of internal carotid artery had reached the stenting testify, but they accepted conservative treatment instead of the stent angioplasty （to control the risk factors and apply symptomatic treatment such as reducing lipid, depressurization and controlling diabetes）. In addition to the stent-assisted angioplasty,the treatment group also received the same symptomatic treatments as the control group. The patients in two groups were examined by using the cervical vascular ultrasound, transcranial doppler uhrasonography（ TCD）, magnetic resonance angiography （ MRA ）, CT perfusion （ CTP）, and digital subtraction angiography（ DSA）, and were scored by the United States National Institutes of health stroke scale （NIHSS） and activities daily living （ ADL）, and the recurrence of stroke within six months etc were investigated. Results The success rate of stent-assisted angioplasty in treatment group was 100%. The stenosis degree after stent-assisted angioplasty of carotid artery dropped were from （ 87.65 ± 7. 63 ） % to （12. 58± 4. 83 ） %, 5 cases appeared transient drop in blood pressure and heart rate. 8 cases appeared persistent low blood pressure and low heart rate. 6 cases had the perioperative performance of perfusion in transition performance without serious complications such as hemorrhage. The cerebral blood flow（CBF） and cerebral blood volume （CBV） were obviously improved in treatment group before and after op
出处
《中华脑科疾病与康复杂志（电子版）》
2016年第1期29-36,共8页
Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）
基金
2012年山西省科技攻关课题(20120313018-2)
关键词
颈内动脉
支架
缩窄
病理性
治疗结果
Carotid artery,internal
Stents
Constriction,pathologic
Treatment outcome
