颈动脉血管成形支架置入术治疗颈内动脉狭窄临床分析  

Carotid Angioplasty Stenting in the Treatment of Patients with Carotid Artery Stenosis

作　　者：刘建峰[1] 侯凯[1] 李辉[1] 张峰[1] 李鹏[1] 井山泉[1] 

机构地区：[1]河北医科大学第一医院神经外科,河北省石家庄市050031

出　　处：《中国全科医学》2014年第5期588-590,共3页Chinese General Practice

基　　金：河北省科技支撑计划项目(112761141)

摘　　要：目的 探讨颈动脉血管成形支架置入术（CAS）对改善颅外段症状性颈内动脉狭窄患者神经症状和临床预后的可行性、安全性及有效性.方法 选取2004年4月-2012年6月在河北省神经介入诊疗中心住院接受CAS的症状性颈内动脉狭窄患者278例,回顾性分析CAS术前和术后随访记录,采用改良的Rankin分级量表（mRS）评价临床疗效,记录手术相关并发症发生率,1年内同侧缺血性脑卒中发生率,支架内有无再狭窄.结果 278例患者共放置293枚自膨式支架,15例伴有双侧颈内动脉中重度狭窄,137例应用远端脑保护装置,109例患者行预扩张.手术成功率100.0%.随访时间13～96个月,平均37.4个月.术前平均狭窄率为（88.3±9.7）%,术后残余狭窄率为（10.4±6.6）%.与术前相比,症状消失与改善267例,改善率为96.0%;244例（87.8%）患者有良好的结果（mRS评分0～2分）;1年内没有出现同侧缺血性脑卒中.103例（37.1%）出现血管迷走神经反射;29例（10.4%）发生血管痉挛;11处（3.8%）出现支架内超过50%再狭窄;4例（1.4%）伴发急性期支架内血栓形成;2例（0.7%）患者术后伴发颅内出血.结论 CAS是一种改善缺血性脑血管病患者神经症状的安全、有效方法,短中期随访临床疗效满意.Objective To investigate the feasibility, safety and efficacy of carotid angioplasty stenting （CAS） in the treatment of patients with extracranial carotid stenosis and its prognosis. Methods 278 patients with extracranial carotid stenosis underwent carotid angioplasty and stenting in our institution from April 2004 to June 2012 were selected. Their following up re- cords before and after CAS, clinical efficacy evaluated by modified Rankin Scale score （mRS）, frequency of procedure related complications, recurrence rate of ipsilateral ischemic stroke within one year and in - stent restenosis were reviewed retrospective- ly. Results 278 cases were placed with 293 self-expanding stents, 15 cases had bilateral severe carotid artery stenosis, 109 cases had routine pre - expansion and 137 cases were applied distal cerebral protection devices. All the operations were success- ful. The patients were followed up for 13 to 96 months, with an average of 37.4 months. The mean preoperative stenosis rate was （88. 3 ＋9.7）%, the residual stenosis rate after operation was （10.4 ＋ 6. 6）%. Compared with before operation, the symp- toms were disappeared and improved in 267 cases, with a symptom improvement rate of 96. 0%. 244 patients （87. 7% ） had fa- vorable outcomes （ mRS score 0 - 2）. Ipsilaterat ischemic stroke did not recur within one year. Vascular vagus reflex showed in 103 cases （37.1%）. Vascular spasm showed in 29 cases （ 10. 4% ）. More than 50% in - stent restenosis showed in 11 cases, with an incidence of 3.8%. Four cases were associated with acute stent thrombosis, with an incidence of 1.4%. Two cases （0.7%） were accompanied by intracranial hemorrhage. Conclusion Carotid angioplasty stenting in patients with carotid artery stenosis is safe and effective, which can improve neurologic symptoms and clinical outcome in selected patients. Short and medi- um following up results are also satisfactory.

关 键 词：颈动脉狭窄 血管成形术 药物洗脱支架 治疗结果 

分 类 号：R543.5[医药卫生—心血管疾病]