对侧颈内动脉闭塞患者的颈动脉血管内支架置入治疗研究  

Endovascular stenting for patients with high-grade ICA atherosclerotic stenosis combined with contralateral ICA occlusion

作　　者：石进[1] 张英谦[1] 吕强[1] 张卫清[1] 王健[1] 朴龙松[2] 宋东林[1] 

机构地区：[1]空军总医院神经内科,北京100036 [2]空军总医院导管室,北京100036

出　　处：《中华神经医学杂志》2007年第7期692-696,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨血管内支架置入治疗对侧颈内动脉闭塞的颈内动脉高度狭窄患者的安全性和疗效。方法在脑血管造影后,对7例一侧颈内动脉闭塞另一侧颈内动脉高度狭窄的患者在使崩脑保护装置下置入自膨式支架,其中4例行球囊预扩张或后扩张术。结果患者颈内动脉狭窄平均由83.6%±11.4%下降至12.4%±4.8%。3例患者保护伞装置回收有黄色斑片状物质。1例患者术中出现短暂全脑缺血的表现,1例发生了有症状的心率及血压下降,2例出现无症状的自行缓解的支架侧颈内动脉痉挛。随访6个月未发生前循环短暂性脑缺血和卒中事件,超声检查未发现支架部位明显再狭窄和支架形态改变。结论血管内支架置入治疗对侧颈内动脉闭塞的颈内动脉严重狭窄的方法安全可行,有一定的疗效,但须进行长期的对照研究。Objective To investigate the feasibility, safety and short-term outcomes of carotid angioplasty and stenting （CAS） for the treatment of patients with high-grade internal carotid artery （ICA） atherosclerotic stenosis combined with contralateral ICA occlusion. Methods Seven cases with high-grade ICA atherosclerotic stenosis combined with contralateral ICA occlusion were treated with self-expanding stents under cerebral protection devices, among which four cases underwent balloon predilation or postdilatation. Results The average ICA stenosis rate decreased from （83.6%±11.4%） before CAS to 02.4%±4.8%） after CAS. Milk yellow atherosclerotic plaques were observed in angioguard after CAS for three cases; one case developed transient intraoperative global cerebral ischemia, one case, symptomatic drop in heart rate and blood pressure and two cases, asymptomatic catabatic stent-side ICA vasospasm. Within the half a year of follow-up study, no anterior circulation TIAs or stroke was complained, and no significant restenosis or distortion in stent form was detected by ultrasonic inspection. Conclusion CAS is a safe and feasible method in the treatment of high-grade ICA stenosis with contralateral ICA occlusion, but its long-term efficacies and side effects need further investigation.

关 键 词：颈内动脉闭塞 颈内动脉狭窄 支架置入术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]