颈动脉支架成形术治疗颈内动脉重度狭窄伴对侧颈动脉闭塞的疗效  

Outcomes of carotid artery stenting for severe carotid stenosis in patients with contralateral occlusion

作　　者：唐骁[1] 郭大乔[1] 符伟国[1] 陈斌[1] 蒋俊豪[1] 徐欣[1] 杨珏[1] 史振宇[1] 竺挺[1] 董智慧[1] 王利新[1] 原野[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》2012年第7期527-530,共4页Chinese Journal of General Surgery

摘　　要：目的评价脑保护下颈动脉支架成形术治疗一侧颈内动脉重度狭窄伴对侧颈动脉闭塞的疗效。方法回顾性分析38例患者的临床资料，包括围手术期30d内及中远期并发症。结果即刻成功率为100％（38／38），围手术期无死亡病例及缺血性脑卒中等严重并发症发生，总并发症发生率34．2％（13／38），其中一过性脑缺血发作5．3％（2／38）。随访率86．8％（33／38），平均随访时间（29±13）个月。随访期间死亡率0，总并发症发生率12．1％（4／33），其中再发一过性脑缺血发作6．1％（2／33），无再发缺血性脑卒中病例。23例患者在手术前后行全脑CT灌注成像，结果显示术侧大脑半球灌注情况较术前改善。结论对于一侧颈内动脉重度狭窄伴对侧颈动脉闭塞的高危患者，脑保护下颈动脉支架成形术具有满意的围手术期结果和较好的远期脑卒中预防疗效。Objective To analyze the perioperative mortality, stroke rates and late benefits of carotid artery stenting for the treatment of unilateral severe stenosis of carotid artery with contralatcral obliteration in a single medical center. Methods Clinical data of 38 cases were analyzed retrospectively, including postoperative period and follow-up. Results The technical success rate was 100% （38/38） with no peri-operative 30-day mortality or ischemic stroke. The overall peri-operative complication rate was 34. 2% （ 13/38）, including transient ischemic attack （TIA） in 5.3% （2/38）. The average follow-up time was （29±13 ） months with follow-up rate of 86. 8% （33/38）. The mortality was 0 and the overall complication rate was 12. 1% （4/33）, including TIA in 6. 1% （2/33）. No patients had recurrent stroke. Twenty-three cases underwent whole brain CT perfusion evaluation before and after the therapy. A significant improvement of the perfusion parameters was observed in the stenotic side after CAS. Conclusions CAS contralateral to an occluded carotid artery can be performed with acceptable perioperative mortality and stroke risk rates, as well as a satisfactory long-term beneficial effect in stroke prevention.

关 键 词：颈动脉狭窄 血管成形术 卒中 支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学]