症状性颅内动脉狭窄血管内支架成形术围手术期脑血管并发症的临床分析  

Analysis of Complications of Stent-assistant Angioplasty of Symptomatic Intracranial Artery Stenosis

作　　者：高峰[1] 姜卫剑[1] 杜彬[1] 徐晓彤[1] 金旻[1] 董可辉[2] 

机构地区：[1]首都医科大学附属天坛医院急诊介入科,北京100050 [2]首都医科大学附属天坛医院神经内科,北京100050

出　　处：《神经损伤与功能重建》2008年第6期388-392,共5页Neural Injury and Functional Reconstruction

基　　金：国家十五科技攻关课题基金项目(No.2004BA714B07)

摘　　要：目的:观察症状性颅内动脉狭窄血管内支架成形术的围手术期脑血管并发症,并探讨其相关危险因素。方法:回顾性分析169例接受血管内支架成形术的症状性颅内动脉狭窄患者(181处病变,狭窄率≥50%)脑血管并发症的发病情况。结果:20例(11.8%)出现脑血管并发症:脑卒中10例(5.9%),其中症状性脑出血4例,死亡2例;缺血性卒中6例;靶病变部位急性血栓形成6例,经动脉内溶栓后即刻再通,均无后遗症;无症状性脑出血2例;短暂性脑缺血发作1例;无症状性动脉夹层1例。围手术期未规范抗血小板治疗与靶病变部位急性血栓形成显著相关(P=0.027);分层分析结果显示同一个部位双支架串联植入与并发颅内出血显著相关(P=0.005)。结论:症状性颅内动脉狭窄血管内支架成形术的脑血管并发症表现形式多样,同一个部位双支架串联植入是并发脑出血的一个独立危险因素,围手术期未规范抗血小板治疗易导致靶病变部位急性血栓形成。Objective：To retrospectively evaluate the cerebrovascular complications from elective stent placement for symptomatic intracranial stenosis and to explore preliminarily which factors are associated with complications. Methods： Records were reviewed of 181 consecutive elective stent placement procedures in 169 patients with symptomatic intracranial stenosis of more than 500%diameter reduction. Complications were evaluated. Stratification analysis was used to assess the significant relationship （P〈0.05） between a potential risk factor and a complication. Results： Complications occurred in 20 patients （11.8 %） of 169 patients. Ten patients （5.9 % ） had stroke （four patients had symptomatic intracranial hemorrhages （ICHs）, and two of these patients died. Six patients had ischemic strokes）. Six patients had targevlesion thrombosis of which intrathrombus thrombolysis resulted in early complete patency without sequelae. Two had asymptomatic ICHs, one had transient ischemic attack, and one had asympto matic dissection. Perioperative noncompliance with antiplatelet therapy was found to be significantly associated with target-lesion thrombosis （P= 0. 027）. Stratification analysis revealed a significant correlation between the use of double stents for a lesion and ICH （P = 0. 005）. Conclusion.. Cerebrovascular complications from elective stent placement for intracranial stenosis are diverse. The use of double stents for a lesion is an independent risk factor for ICH. Perioperative noncompliance with antiplatelet therapy is associated with a higher frequency of target lesion thrombosis..

关 键 词：血管内支架成形术 颅内动脉狭窄 并发症 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学]