不符合NASCET纳入标准的高危有症状颈动脉狭窄患者的颈动脉成形支架置入术治疗  

Carotid angioplasty and stenting symptomatic NASCEI＇-ineligible for carotid stenosis in high-risk patients

作　　者：郝强[1] 李慎茂[1] 焦力群[1] 缪中荣[1] 朱凤水[1] 凌锋[1] 

机构地区：[1]首都医科大学宣武医院介入放射诊断治疗中心,北京100053

出　　处：《国际脑血管病杂志》2010年第5期331-337,共7页International Journal of Cerebrovascular Diseases

基　　金：“十一五”国家科技支撑技术项目（2007BA105B04）

摘　　要：目的 探讨支架置入术治疗不符合NASCET纳入标准的高危有症状颈动脉狭窄患者的有效性和安全性.方法 对20例不符合NASCET纳入标准的高危有症状颈动脉狭窄患者进行颈动脉支架置入术治疗,其中男性12例,女性8例,年龄62～76岁（平均69岁）,短暂性脑缺血发作11例,脑梗死9例.所有患者数字减影血管造影显示颈动脉狭窄程度＞70%（NA-SCET标准）,其中-侧颈动脉重度狭窄9例（2例为内膜切除术后再狭窄）,双侧颈动脉重度狭窄6例,一侧颈动脉闭塞伴对侧重度狭窄5例（1例为鼻咽癌放疗术后）.所有患者均使用栓子保护装置,均采用预扩张和自膨式支架.结果 手术成功率100%,残余狭窄率均＜30%.所有患者术中均出现不同程度的一过性心率和血压下降,1例患者并发微栓子栓塞.其余患者围手术期内无缺血性卒中发作.术后复查颈动脉超声见狭窄显著改善.术后1个月和3个月随访均未发现同侧缺血性卒中和冠状动脉缺血事件.结论 颈动脉支架置入术创伤小、围手术期并发症少,治疗外科手术高危的有症状颈动脉狭窄是安全和有效的.Objective To investigate the efficacy and safety of carotid angioplasty and stenting for carotid stenosis in high-risk symptomatic NASCET-ineligible patients. Methods Twenty patients with symptomatic carotid stenosis at high risk ineligible for NASCET were treated with carotid angioplasty and stenting, 12 of them were men, and 8 were women, the patients ranged in age from 62 to76 years （mean age, 69 years）. Eleven patients had transient ischemic attack and 9 had cerebral infarction. Digital subtraction angiography showed that the degree of carotid stenosis in all patients was 〉 70% （NASCET criteria）. Among them, 9 patients had unilateral carotid artery severe stenosis （2 had restenosis after endarterectomy）, 6 had bilateral carotid artery severe stenosis, 5 had unilateral carotid artery occlusion with contralateral severe sentoses （1 had undergone cervical radiotherapy for nasopharyngeal carcinoma）. The embolic protection devices, predilation, and self-expandable stents were used in all patients. Results The success rate of the procedure was 100%. The residual stenosis rate was 〈 30%. The different levels of a transient decline in heart rates and blood pressure occurred in all the patients during the procedure. One patient was complicated with microembolic embolism. No ischernic stroke occurred in the remaining patients in the periprocedure. The postoperative examination with carotid ultrasound showed that the stenoses were improved significantly. No ipsilateral ischemic stroke and coronary ischemic events were observed at 1 mad 3 months follow-up after the procedures. Conclusions Carotid artery stenting is less invasive, and the perioperative complications are fewer. The treatment of symptomatic carotid stenosis with high surgical risks is safe and effective.

关 键 词：颈动脉狭窄 颈动脉疾病 血管成形术 支架 卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]