摘要
目的探讨近端保护技术下血管内重建颈动脉重度狭窄伴颅外段严重迂曲的可行性、有效性和安全性.方法回顾性分析2011年1月至2017年8月间苏州大学附属第二医院21例颈动脉重度狭窄伴颅外段严重迂曲患者的临床资料,其中16例患者为症状性,采用近端保护技术下行颈动脉支架成形术(CAS).入组患者术前及出院时采用美国国立卫生研究院卒中量表(NIHSS)评估病情.术后定期对患者的临床预后和血管形态学进行随访.结果21例患者全程在近端保护技术下成功完成CAS操作,平均封堵时间为241.0(232.5-261.0)s.其中9例封堵1次,6例封堵2次,6例封堵3次.手术相关并发症3例,均为术中出现短暂性脑缺血发作(TIA),最长发作时间10 min.16例症状性狭窄患者入院和出院时NIHSS评分比较差异无统计学意义(P>0.05);支架成形术后血管残余狭窄率为(13±6)%,与术前(87±16)%比较,差异有统计学意义(t=19.948,P<0.05);21例患者随访期间无心肌梗死、再发缺血性卒中及死亡等不良事件,其中6例患者在随访期间行脑血管造影或CT血管成像检查,支架处无再狭窄.结论近端保护技术下血管内重建颈动脉重度狭窄伴颅外段严重迂曲是一种较为安全、有效的治疗方法.
Objective To investigate the feasibility,efficacy and safety of endovascular reconstruction of the carotid artery with severe stenosis and extracranial distortion under proximal protection.Methods A retrospective analysis of 21 patients with severe carotid stenosis and extracranial distortion who were admitted to the Second Affiliated Hospital of Soochow University between January 2011 and August 2017,of which 16 patients were symptomatic stenosis with acute ischemic stroke.All the patients were treated with carotid artery stenting under(CAS)proximal protection technique,and assessed with the National Institutes of Health Stroke Scale(NIHSS)before the treatment and hospital discharge.The clinical outcome and vascular morphology were followed-up regularly after the treatment.Results Twenty-one patients were successfully completed the CAS procedure under the proximal protection technique,the average blocking time was 241.0(232.5-261.0)seconds.Nine patients received 1block attempt,6 patients received 2 block attempts,and the other 6 patients received 3 block attempts.Three patients experienced transient ischemic attack(TIA)during the procedure,the maximum duration of TIA was 10 minutes.In 16 patients with symptomatic stenosis,there were no significant differences in NIHSS score before CAS procedure and hospital discharge(P>0.05).The residual stenosis rate of the carotid artery after stenting was(13±6)%,compared with preoperative(87±16)%,which appeared a significant difference(t=19.948,P<0.05).All the patients had no adverse events such as myocardial infarction,recurrent ischemic stroke and death in the follow-up period.Restenosis was assessed in 6 patients by DSA or CTA and no restenosis was found.Conclusion Endovascular reconstruction of the carotid artery with severe stenosis and extracranial distortion under proximal protection technique has been proven as a safe and effective therapy.
作者
欧志杰
黄志超
陈菊萍
徐加平
毛学宇
尤寿江
刘春风
曹勇军
肖国栋
Ou Zhijie;Huang Zhichao;Chen Juping;Xu Jiaping;Mao Xueyu;You Shoujiang;Liu Chunfeng;Cao Yongjun;Xiao Guodong(Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;the Department of Neurology,Changshu TCM Hospital Affiliated to Nanjing University of Chinese Medicine,Changshu 215500,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第45期3568-3573,共6页
National Medical Journal of China
基金
苏州市2018年科技发展计划项目(sys2018061)。
关键词
颈动脉狭窄
支架
近端保护技术
Carotid stenosis
Stents
Proximal protection technique
