脑保护下颈动脉支架成形术治疗颈动脉中重度钙化狭窄的疗效分析  

Curative effect analysis of carotid artery stenting in the treatment of carotid angioplasty and stenting with moderate or severe calcification using the distal embolization protected device

作　　者：张路[1] 唐骁[1] 符伟国[1] 史振宇[1] 吕鹏[2] 戴媛媛[2] 王玉琦[1] 郭大乔[1] 

机构地区：[1]复旦大学附属中山医院血管外科-复旦大学血管外科研究所 [2]复旦大学附属中山医院放射科,上海200032

出　　处：《复旦学报（医学版）》2016年第5期543-549,共7页Fudan University Journal of Medical Sciences

基　　金：上海市科委基金(074119503);国家自然科学基金(81570433)~~

摘　　要：目的评价脑保护下颈动脉支架成形术(carotid angioplasty and stenting,CAS)治疗颈动脉中重度钙化狭窄的安全性及有效性。方法 28例颈动脉中重度钙化狭窄患者接受了脑保护下颈动脉支架植入术,均接受了术前颈动脉CT血管造影检查及术前术后头颅MRI检查,评价术后新发弥散加权(diffusion weighted imaging,DWI)病灶、术后支架即刻残余狭窄率与钙化斑块的关系。结果 28例次CAS的即刻成功率为100%。围手术期无死亡或心肌梗死等严重并发症。术后3天内复查头颅MRI:新发DWI病灶15例(53.6%),均无神经系统症状。根据术后有无新发DWI病灶,将患者分为阳性组和阴性组,比较两组钙化斑块的位置、体积大小、钙化弧度(calcium radian,CR)及Agatston钙化评分、钙化CT值、钙化斑块体积百分比和颈动脉斑块最大厚度,差异均无统计学意义(P>0.05)。术后12个月内,1例患者发生手术侧脑卒中,其余27例恢复良好,无短暂性脑缺血发作或脑卒中发生。术后1年复查颈动脉超声,并随访颈部X线,支架内再狭窄发生率为0,支架断裂发生率为0。结论在实施远端脑保护装置的情况下,CAS对颈动脉中重度钙化狭窄是一种安全有效的治疗方法。钙化斑块的位置、体积大小、CR、Agatston钙化评分、钙化斑块CT值、钙化斑块体积百分比和颈动脉斑块最大厚度对术后新发DWI病灶的发生率无明显影响。Objective To evaluate the safety and efficacy of carotid angioplasty and stenting（CAS）in the treatment of carotid artery stenosis with moderate or severe calcification using the distal embolization protected device. Methods Twenty-eight carotid artery stenosis patients with moderate or severe calcified plaque accepted CAS using the distal embolization protected device.Patients underwent carotid artery CT angiography before CAS,and magnetic resonance imaging of the brain preand post-operatively.We evaluated the relationship between calcified plaque and the rate of immediate postoperative residual stenosis as well as the postoperative new diffusion-weighted lesions. ResultsThe immediate technical success rate was 100% in 28 patients.No death or myocardial infarction occurred during the perioperative period.Fifteen cases（53.6%）of new diffusion-weighted lesions（DWI）occurred according to postoperative cranial MRI.The new diffusion-weighted lesions positive group and negative group were compared.While there was no significant difference in the calcified plaque position,volume,calcium radian（CR）and Agatston calcification score,CT calcification value,calcified plaque volume percentage and thickness between the two groups.Within 12 months after CAS,one patient suffered ischemic stroke on the side of CAS and the remaining 27 patients after CAS recovered well without transient ischemic attacks（TIA）or ischemic stroke.After 1 year,the incidence rate of carotid artery restenosis and stent fracture was zero. Conclusions With the distal embolization protected device,carotid artery stenting is a safe and effective treatment for carotid artery stenosis with moderate or severe calcified plaque.The location,volume,CT calcium value,the volume percentage and thickness of calcified plaque have no influence on the occurrence rate of the postoperative new diffusion-weighted lesions and restenosis.

关 键 词：颈动脉狭窄 支架 钙化 新发DWI病灶 残余狭窄率 

分 类 号：R654.4[医药卫生—外科学]