颈动脉经皮血管内成形及支架置入术预防非干预脑动脉系统卒中效果  

The Apoplectic Effective Prevention of Un-interferential Cerebric Arterial System in Percutaneous Transluminal Angioplasty and Stenting of Carotid Stenosis

作　　者：杜会山[1] 耿晓坤[1] 刘建国[2] 刘怀翔[3] 魏建朝[1] 张伟东[1] 孟繁花[1] 曾艳芳[1] 谈晓牧[1] 

机构地区：[1]首都医科大学潞河教学医院神经内科,北京101100 [2]解放军海军总医院神经内科,北京100037 [3]天津医科大学第二附属医院神经内科,天津300211

出　　处：《临床误诊误治》2012年第8期59-63,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨颈动脉颅外段狭窄介入治疗对非干预脑动脉系统卒中二级预防的效果。方法选择在我院住院的213例缺血性卒中并单侧重度颈动脉颅外段狭窄,119例采用自膨式支架经股动脉入路行经皮血管内成形及支架置入术(PTAS),为介入组;余94例仅接受药物治疗,为药物组。入组时两组一般资料及卒中危险因素、合并其他脑动脉狭窄情况等比较差异均无统计学意义(P>0.05)。对两组进行为期3年左右随访观察,记录随访期间患者卒中和死亡事件,并进行比较。结果 213例中6例失访,其中介入组1例,药物组5例。介入组卒中总复发率、症状性复发率、无症状性复发率及多次复发率均显著低于药物组,差异有统计学意义(P<0.01,P<0.05)。介入组PTAS干预的颈动脉系统供血区和非PTAS干预的脑动脉系统供血区的卒中复发率显著低于药物组重度狭窄颈动脉供血区和其他脑动脉供血区(P<0.01,P<0.05)。随访期间介入组死亡2例,药物组死亡4例。结论 PTAS是治疗颈动脉颅外段狭窄较安全、低创的手段,对颈动脉颅外段重度狭窄患者有显著卒中二级预防效果,不仅体现在开通颈动脉系统供血区,也体现在其他脑动脉系统供血区。Objective To explore the secondary preventive effect of un-interferential eerebric arterial system in interventional therapy for the extracranial segment stenosis of carotid artery. Methods Among 213 patients with ischemic stroke combined with unilateral severe extracranial segment stenosis of carotid artery, 119 patients underwent percutaneous transluminal angioplasty and stenting （FFAS） by self expanding stent through femoral artery （interventional group）, while the other 94 patients only received medication （control group）. There was no significant difference in the demographic data, apoplectic risk factors and combined with other cerebric arteriostenosis between the two groups （P 〉0. 05）. The two groups were followed up for 3 years, and the incidences of stroke and death were recorded and compared. Results 6 patients were lost in follow-up, including 1 patient of the interventional group and 5 patients of the control group. The total recurrence rate, symptomatic recurrence rate, non-symptomatic recurrence rate and multiple recurrence rates of stroke in interventional group were significantly lower than that of control group （P 〈 0.01, P 〈 0.05）. The apoplectic recurrence rate on the interferential domains of carotid artery system in interventional group by PTAS or no PTAS were significantly lower than that of control group （P 〈 0.01, P 〈 0.05 ）. There were 2 deaths in interventional group and 4 deaths in control group during the follow up. Conclusion PTAS is an effective, safe and low-traumatic measure to treat extracranial angiostenosis. FFAS can show significant secondary preventive effects for patients with severe extracranial angiostenosis in stroke on the domains of the intervened carotid arteries and other cerebral arteries.

关 键 词：颈动脉狭窄 颈动脉 血管成形术 支架 脑血管意外 

分 类 号：R743.3[医药卫生—神经病学与精神病学]