颈内动脉狭窄处扭曲的血管内治疗  

Endovascular management of symptomatic carotid stenosis combined with kinking

作　　者：王利军[1] 王大明[1] 刘加春[1] 陆军[1] 祁鹏[1] 李达[1] 姜学丽[1] 翟乐乐[1] 

机构地区：[1]卫生部北京医院神经外科,100730

出　　处：《中华外科杂志》2011年第2期105-108,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（30571915）

摘　　要：目的 探讨血管内支架成形术治疗颈内动脉狭窄处扭曲的必要性、可行性和安全性.方法 选择2003年12月至2009年12月经数字减影血管造影（DSA）检查证实的症状性颈内动脉狭窄且狭窄处伴扭曲的12例患者,采用血管内支架成形术处理颈动脉狭窄伴扭曲,分析其临床、影像学、支架成形术和随访观察资料,评价治疗效果.结果 12例颈内动脉狭窄伴扭曲的患者全部成功实施血管内支架成形术,支架置入成功率100%,无支架相关死亡或致残.12例患者共置入自膨式支架14枚,平均狭窄率由术前的85.6%下降至11.2%;扭曲角度（Metz观测分类法）由术前＜90°变为＞120°;无围手术期短暂性脑缺血发作（TIA）和脑卒中发生,临床症状改善或消失.临床随访6～72个月,发生支架同侧和对侧TIA各1例;5例患者行DSA检查,其中1例发生再狭窄并在支架远端发生新的扭曲,再次支架置入治疗,2年后CT血管造影（CTA）复查未见扭曲和支架内再狭窄;另外7例行颈部血管超声检查,未见再狭窄和扭曲.结论 血管内支架成形术治疗颈内动脉狭窄伴扭曲,技术上是可行、安全的,可能有助于减少脑缺血发生,但有待于进一步观察.Objective To study the necessity, feasibility, security of carotid angioplasty and stenting （CAS） for symptomatic carotid stenosis combined with kinking. Methods Twelve patients with symptomatic carotid stenosis and kinking demonstrated by digital subtraction angiography （DSA） received CAS from December 2003 to December 2009. There were 9 male and 3 female patients, age ranged from 59 to 77 years（mean 69.3 years）. All the patients＇ clinical, imaging, intervention and follow up data were collected and analyzed. Results All CAS procedures were successfully performed with 14 self-expandable stents placed. The mean degree of stenosis was reduced from 85. 6% before stenting to 11.2% after stenting,the angle of kinking, according to Metz＇ category, were improved from less than 90° to more than 120° in each case. No perioperative procedure related stroke and tranient ichemic attack （TIA） occurred. The clinical symptoms and signs of cerebral ischemia were improved or disappeared for all patients. During follow-up of these 12 patients for 6 to 72 months, one patient experienced ipsilateral carotid territory TIA and another patient experienced contralateral carotid territory TIA. DSA follow up of 5 patients demonstrated 1 case with in-stent restenosis and arterial kinking remote to the stent of internal carotid artery. CAS were performed again and CT angiography follow up demonstrated no kinking and restenosis 2 years after the intervention. Duplex scan of the other 7 patients demonstrated neither kinking nor restenosis. Conclusions CAS seems to be feasible and safe for the patients with symptomatic kinking and stenosis, and maybe helpful to lower the risk of cerebral ischemia, but further study is needed.

关 键 词：颈动脉狭窄 颈动脉扭曲 支架成形术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]