球囊扩张支架成形术治疗症状性MCA狭窄的临床观察  

Clinical study on s ymptomatic middle cerebral artery stenosis treated with stent -assisted angioplasty

作　　者：武国德[1] 李珍花[2] 张振昶[1] 李鑫[1] 李建雄[1] 滕庆兰[3] 罗福明[1] 张廷华[1] 

机构地区：[1]兰州大学第二医院神经内科,甘肃兰州730030 [2]兰州大学第二医院骨科,甘肃兰州730030 [3]兰州大学第二医院介入放射科,甘肃兰州730030

出　　处：《甘肃医药》2013年第9期646-649,共4页Gansu Medical Journal

摘　　要：目的：评估球囊扩张支架在治疗症状性大脑中动脉狭窄的安全性及有效性，并对相关问题进行探讨。方法：对2007年至2010年经治的12例由大脑中动脉段狭窄引起的缺血性脑卒中患者实施经皮穿刺大脑中动脉狭窄球囊扩张支架手术，每位患者均有DSA全脑血管造影资料，1例为急症，术前一次服用氯吡咯雷300mg，择期11例术前3天口服氯吡咯雷75mg＋阿司匹林100mg，手术在全麻下进行，全程静脉肝素化，再次行脑血管造影，确定狭窄位置及狭窄程度，并据此选择直径2．5mm，长度为8．10mm的球囊扩张支架系统，扩张压力为6—8Kpa。记录围手术期并发症，评价狭窄程度的变化及临床表现。结果：1例患者因颈内动脉虹吸段严重迂曲，支架未能通过而放弃手术，其余11例患者成功置入支架11枚，支架释放后大脑中动脉平均狭窄率由术前的85．6％降为术后的5．7％。术中1例患者出现血管痉挛，术后1例患者出现高灌注综合症，给予相应处理后好转；支架内血栓形成1例，溶栓后再通，其余患者临床症状有不同程度改善，以TIA为主的患者临床疗效最为显著。所有患者随访14年，10例患者未出现与治疗血管相关的脑缺血事件，1例患者于术后半年因再次出现缺血性卒中发作而住院治疗。2例患者在随访期间出现程度不等的再狭窄。结论：球囊扩张支架治疗SMCAS在本组病例是安全的，且短期疗效肯定，但中远期再狭窄或闭塞的发生率较高，有一定比例的卒中复发。Objective： To evaluate the effect and safety of the stent-assisted angioplasty treated with the patient of symptomatic middle cerebral artery stenosis （SMCAS） and observe eonnected problem. Methods： we choose 12 patients with isehemie cerebral stroke due to middle cerebral artery （MCA） stenosis. All of them accepted the MCA stenosis stent-assisted angioplasty by balloon-expandable stent system,and each one must take clopidogerl sulfate 75mg and aspirin 100rag in the first 3 days before the surgery. Results：l patients didn＇t get the surgery due to the seriously tortuous of siphon segment of internal carotid artery and the last success. The mean degrees of stenosis after the procedure were reduced from 85.6% to 5.7%. There are 3 cases complication, vasospasm in 1 case, hyperperfusion syndrome in 1 case and thrombopoiesis in 1 case. Followed-up from one year to two years, no patient recurred except one case. Conclusion： The Stent- assisted angioplasty treat patient with SMCAS is effect and safety, but it is likely that the patient will be restenosis in no long time and recur.

关 键 词：支架辅助血管成形术 球囊扩张支架 症状性大脑中动脉狭窄 并发症 再狭窄 

分 类 号：R743[医药卫生—神经病学与精神病学]