脑保护下颈动脉支架成形术并发症的防治  

Complications after carotid artery starting with the use of cerebral protective device

作　　者：郭大乔[1] 唐骁[1] 符伟国[1] 蒋俊豪[1] 陈斌[1] 史振宇[1] 王利新[1] 蔡浩雷[1] 王玉琦[1] 

机构地区：[1]复旦大学附属中山医院血管外科复旦大学血管外科研究所,上海200032

出　　处：《中华普通外科杂志》2010年第7期519-522,共4页Chinese Journal of General Surgery

基　　金：上海市科委基金资助项目（074119503）

摘　　要：目的 探讨脑保护下颈动脉支架成形术（carotid angioplasty and stent placement,CAS）并发症的预防及处理方法.方法 回顾性分析复旦大学附属中山医院2004年12至2009年12月完成的114例（118例次）脑保护下颈动脉支架成形术的并发症及处理情况,包括围手术期30 d内及中远期并发症.结果 114例患者行118例次脑保护下颈动脉支架成形术,即刻成功率为100%,围手术期无死亡病例,无缺血性脑卒中等严重并发症,总并发症发生率32.20%（38/118）,包括颈内动脉痉挛10.17%（10/118）,心动过缓11.02%（13/118）,低血压2.54%（3/118）,短暂性脑缺血发作5.93%（7/118）,股动脉假性动脉瘤2.54%（3/118）.平均随访时间（28±15）个月,随访期间死亡率2.38%（2/84）,总并发症发生率10.71%（9/84）,包括缺血性脑卒中3.57%（3/84）、支架内再狭窄1.19%（1/84）、支架狭窄变形4.66%（4/84）、支架扭曲断裂1.19%（1/84）.结论 脑保护下颈动脉支架成形术后死亡或缺血性脑卒中等严重并发症发生率较低,术前良好的病例选择以及严格的手术适应证把握,是减少CAS术后并发症的关键.Objective To review the prevention and treatment strategies for complications after carotid artery stenting in a single medical center. Methods From December 2004 to December 2009,clinical data of 118 cases of carotid artery stenting with the use of cerebral protective device were analyzed retrospectively. Results The surgical success rate was 100% with no perioperative 30- day mortality or severe complications such as disabling stroke. The overall perioperative complication rate was 32. 20% （38/118）, including carotid artery spasm in 10.17% （10/118）, bradycardia in 11.02% （13/118）, hypotension in 2.54% （3/118）, transient ischemic attack in 5.93% （7/118） and false aneurysm of femoral artery in 2. 54% （3/118） cases. The average follow-up time was （28 ± 15） months. The mortality was 2. 38% （2/84） and the overall complication rate was 10. 71% （9/84） , including ischemic stroke in 3. 57% （3/84） , in-stent restenosis in 1. 19% （ 1/84） , stent deformation in 4. 66% （4/84） and stent fracture in 1. 19% （1/84） cases. Conclusion Death or ischemic stroke and other severe complications after carotid artery stenting under cerebral protective device were low. A careful selection of patients and strict indication for surgery is the key to reduce the complication rate.

关 键 词：血管成形术 颈动脉狭窄 支架 手术后并发症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]