脑血管腔内支架置入治疗症状性脑动脉狭窄20例  

Endovascular stent implantation for symptomatic cerebral artery stenosis in 20 cases

作　　者：周祝谦[1] 李桂杰[1] 李衍滨[1] 韩巨[1] 王子彬[2] 

机构地区：[1]山东大学附属千佛山医院,山东省济南市250014 [2]山东省胸科医院,山东省济南市250013

出　　处：《中国组织工程研究与临床康复》2010年第9期1707-1710,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:关于脑血管支架置入后局部机械性血管壁损伤后发生血管内再狭窄研究中涉及的安全性、病理生理机制及临床疗效尚无确切的结论。目的:探讨脑血管腔内支架置入治疗症状性脑动脉狭窄的安全性、近期临床疗效。方法:对20例症状性脑动脉狭窄患者行脑血管腔内支架置入治疗,狭窄病变22处,位于大脑中动脉6处、颈内动脉6处、椎动脉4处、基底动脉3处,3例为椎-基底动脉狭窄;狭窄长度为3～10mm,平均为7mm,其中6处狭窄长度超过10mm。行自膨式及球囊膨胀式支架置入,使用脑保护装置保护伞12例。结果与结论:20例患者22枚支架均1次放置成功,无一例发生严重并发症,置入后即刻血管造影结果显示,病变段动脉残余狭窄程度小于20%,与治疗前相比较,管腔狭窄明显改善。同时再造影的实质期可见脑组织血流灌注得到改善,临床症状全部得到改善。置入后临床随访6～24个月,20例未再有脑缺血发作,数字减影血管造影随访12～24个月7例,1例出现支架内内膜轻度增生,未引起临床症状。经颅超声多普勒随访结果示狭窄部位血流通畅,支架内未见内膜过度增生,无主要分支血管的闭塞。结果说明脑血管腔内支架置入治疗症状性颅内动脉狭窄安全,近期疗效明显,其长期疗效还需进一步随访观察。BACKGROUND：Cerebrovascular stent may destroy the vessel walls,which can lead to vascular restenosis.There are different versions about the safety,pathologic pharmacology reasons and clinical effect.OBJECTIVE：To evaluate the safety and short-term effect of endovascular stent implantation for symptomatic artery stenosis.METHODS：Totally 20 patients with total 22 lesions diagnosed symptomatic artery stenosis were treated with endovascular stenting.The vascular stenotic lesions involved middle cerebral artery in 6 cases,internal carotid artery in 6 cases,vertebral artery in 4 cases,basilar artery in 3 cases and vertebro-basilar artery in 3 cases.The length of vascular stenotic lesions was 3-10 mm with the average of 7 mm.Both balloon and self-expandable stents were used in 12 cases with embolus protection device.RESULTS AND CONCLUSION：All of the 22 stents in 20 patients were placed successfully in one time.After stent implantation,the vascular angiography showed that the vessels were reformed obviously with the degree of stenosis no more than 20%.The perfusion in cerebrum was improved in parenchymal phase and the symptom was also improved clearly.At 6-24 months follow-up,20 patients never had cerebral ischemia.With follow-up for 12-24 months in 7 patients,digital subtraction angiography displayed that intima hyperplasia was occurred in stent in one patient with no symptom.The stenotic vascular were unobstructed and no intima hyperplasia by transcranial Doppler examinations.The results demonstrated that endovascular stent implantation is a safe and effective treatment for intracranial symptomatic artery stenosis,while its long-term effect needs further study.

关 键 词：脑动脉狭窄 支架置入 脑保护装置 安全性 脑血管植入物 

分 类 号：R772.2[医药卫生—眼科]