球囊扩张术治疗颈动脉支架内急性血栓形成的临床分析  

Rescue strategy for acute carotid stent thrombosis during carotid stenting with balloon dilatation

作　　者：胡伟[1] 任明山[1] 王国平[1] 

机构地区：[1]安徽医科大学附属省立医院神经内科,合肥医学硕士230001

出　　处：《医学研究生学报》2016年第1期83-86,共4页Journal of Medical Postgraduates

摘　　要：目的颈动脉支架内急性血栓形成(acute carotid stent thrombosis,ACST)是支架成形术中/后非常罕见的并发症,能够导致严重的神经功能缺失,且没有统一的治疗方案,及时诊断和合适的治疗对患者的预后至关重要。文中旨在探讨颈动脉支架成形术中,ACST后立即采取球囊扩张术治疗的临床效果和近期随访结果。方法回顾性分析安徽医科大学附属省立医院神经内科2011年3月至2014年12月收治的5例ACST患者的临床资料,统计分析其临床表现、治疗方案及影像学检查结果,并进行90d门诊随访,分析预后结果。结果 5例患者中1例表现为言语不清伴右侧肢体无力,CT血管造影(computed tomography angiogram,CTA)显示左侧颈内动脉狭窄约90%;2例表现为左侧肢体无力,CTA显示右侧颈内动脉狭窄约70%;2例表现为短暂性脑缺血发作,其中1例反复发作性右侧肢体无力伴麻木,CTA显示左侧颈内动脉狭窄约90%,另1例反复发作性左侧肢体无力,CTA显示右侧颈内动脉狭窄约70%。5例患者均在支架植入后数分钟内发生支架内血栓形成且未完全堵塞血流,所有患者尚未发生神经功能缺损症状。行支架内球囊扩张术后瞬间血栓消失,脑血流恢复,术后磁共振检查均未出现新发脑梗死病灶。随访发现所有患者颈动脉超声检查无支架内血栓形成,CT检查无新发脑梗死。结论在行颈动脉支架成形术过程中,若发生支架内急性血栓形成且尚未形成血凝块,球囊扩张术是有效的治疗方法。Objective To report the clinical effect and early follow up results of balloon dilatation method for 5 patients with diagnosed acute carotid stent thrombosis （ACST） following carotid artery stenting. Methods We retrospective reviewed the clinical manifestations, early diagnosis and prompt treatment and early follow up results of five patients with ACST admitted to our department from March 2011 to December 2014. Results Acutestent thrombosis of 5 patients were occured within a few minutes after stenting rapidly reperfused after balloon dilatation with distal filter protection. No patients were found neurologic deterioration. All patients were followed up for six months without new cerebral infarction and carotid stent thrombosis. Conclusion Balloon dilatation might be con- sidered as one of the most effective treatment to ACST for internal carotid artery stenosis before clot formation.

关 键 词：急性血栓 颈动脉 支架 球囊扩张术 

分 类 号：R651[医药卫生—外科学]