颈动脉支架成形术后高灌注综合征一例并文献复习  

Hyperperfusion syndrome following carotid artery stenting:a case report and review of literatures

作　　者：佘家贵[1] 刘建民[1] 洪波[1] 许奕[1] 黄清海[1] 赵文元[1] 张珑[1] 张鑫[1] 赵瑞[1] 

机构地区：[1]上海第二军医大学长海医院神经外科,200433

出　　处：《介入放射学杂志》2004年第S1期156-158,共3页Journal of Interventional Radiology

摘　　要：目的　高灌注综合征是颈动脉支架成形术少见 ,但很严重的并发症 ,我们报道 1例颈动脉支架成形术后高灌注综合征的临床特点。方法　分析 2 0 0 4年 3月我科收治 1例严重颅外段颈动脉狭窄行支架成形术后出现的高灌注综合征的临床表现和影像学特点。结果　在全麻下行颈动脉支架成形术 ,先后植入 6mm× 30mm、10mm× 4 0mmPrecise支架 ,予以 5mm× 2 0mm球囊导管后扩 ,狭窄明显缓解 ,患者出现血压增高至 2 30～ 30 0 10 0～ 130mmHg ,心率缓慢 5 5次 min ,急查头颅CT示右侧基底节区出血约80ml,急诊在全麻下行开颅血肿清除术 ,术后患者呈植物生存状态。结论　支架成形术后脑出血与脑过度灌注有关 ,同侧 >90 %高度狭窄合并有对侧狭窄是高灌注综合征危险因素之一。术中术后TCD监测 ,及时发现脑组织高灌注状态 ,有助于减少脑出血并发症发生。Objective Hyperperfusion syndrome is a rare and devastating complication of carotid artery angioplasty and stenting(CAS).We report the clinical character of this complication in a patient undergoing CAS.Methods This report is a retrospective review of one case with severe extracranial carotid stenosis of carotid angioplasty and stenting performed on March,2004.We analysesed the clinical and imagining character of this hyperperfusion syndrome related to CAS. Results The patient with subtotal occlusion of the right internal carotid artery had a 10-mm lesion treated percutaneously with implantation of 2 stents (Precise 6×30mm、10×40mm) under general anesthesia.The stenosis was postdilated with a 5×20mm balloon. Postprocedural angiography showed no significant stenosis, the blood pressure varied between 230～300/100～130mmHg,the heart rate decreased to 55/min. An urgent brain CT revealed extensive hemorrhage with 80ml in the right basal ganglia. Surgical evacuation was performed urgently under general anesthesia.After operation the patient presented with vegetative status.Conclusions Intracerebral hemorrhage is related to cerebral hyperperfusion after CAS.One of risk factors for hyperperfusion syndrome is of severe ipsilateral stenosis of 90% severity or greater with collateral carotid stenosis. Peri-and postintervention TCD monitoring is mandantory, TCD can be identified patients at risk of cerebral hyperperfusion,to decrease postintervention hemorrhage.

关 键 词：颈动脉狭窄 支架 高灌注综合征 脑出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]