症状性颈动脉狭窄合并未破裂颅内动脉瘤的临床研究  

Symptomatic carotid artery stenosis complicated with unruptured intracranial aneurysms

作　　者：梁永平[1] 王君[1] 李宝民[1] 李生[1] 曹向宇[1] 刘新峰[1] 

机构地区：[1]解放军总医院神经内科,北京100853

出　　处：《中华老年心脑血管病杂志》2015年第1期21-24,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81371296)

摘　　要：目的 探讨颈动脉狭窄合并未破裂颅内动脉瘤患者的临床特点、发病率及临床处理策略.方法 2012年7月1日～2013年12月31日于我中心就诊,通过数字减影血管造影（DSA）确诊的狭窄程度≥50％的颈动脉狭窄患者191例,通过电话和门诊进行3～12个月随访,其中5例患者进行了DSA随访.结果 191例患者中,合并未破裂动脉瘤患者12例,检出率6.3％.12例未破裂颅内动脉瘤患者中,9例干预治疗,其中1例单纯行颈动脉狭窄支架置入,1例行动脉瘤手术夹闭后择期行颈动脉内膜剥脱术,2例单纯行动脉瘤栓塞,5例行狭窄支架置入并动脉瘤栓塞;另3例未干预治疗,仅控制危险因素,定期随访.所有患者均合并有糖尿病,高血压及吸烟等危险因素.随访期间,未破裂动脉瘤干预患者中,有1例患者动脉瘤复发;未干预患者中,有1例患者频繁短暂性脑缺血发作,给予抗血小板治疗后好转.结论 在颈内动脉狭窄患者中,颅内动脉瘤发生率较高.对颈动脉狭窄合并颅内动脉瘤患者通过个性化的方案治疗后,可取得良好治疗效果.Objective To study the clinical features,incidence and clinical treatment strategies of symptomatic carotid artery stenosis complicated with unruptured intracranial aneurysms.Methods One hundred and ninety-one carotid artery stenosis （≥50%） patients confirmed by digital subtraction angiography （DSA） in our hospital from 2012-07-01 to 2013-12-31 were followed up for 3-12 months by telephone or at outpatient department.Of these patients,5 were followed up by imaging.Results Unruptured intracranial aneurysm was detected in 12 （6.3 %） out of the 191 patients.Of these 12 patients,9 received interventional therapy,1 underwent simple carotid artery stenting,1 underwent exfoliative surgery of carotid artery intima after carotid aneurysm operation,2 received simple carotid embolic surgery,5 received carotid artery stenting and carotid aneurysm operation,3 who did not receive interventional therapy were followed up at a regular time with their risk factors controlled.Risk factors for diabetes mellitus and hypertension were found in all the patients.Carotid artery aneurysm recurred in 1 patient who received interventional therapy while transient cerebral ischemia occurred in 1 patient who did not receive interventional therapy and improved after anti-platelet therapy.Conclusion The incidence of intracranial aneurysm is rather high in patients with symptomatic carotid artery stenosis.Individual treatment modality can achieve good therapeutic outcomes in symptomatic carotid artery stenosis patients with intracranial aneurysm.

关 键 词：颈动脉狭窄 颅内动脉瘤 血管造影术 数字减影 血小板聚集抑制剂 糖尿病 高血压 吸烟 

分 类 号：R743.3[医药卫生—神经病学与精神病学]