血管内支架成形术治疗颅外段颈内动脉夹层的疗效分析  

Curative effect analysis of intravascular stent angioplasty for extracranial internal carotid artery dissection

作　　者：王宫[1] 卫飞[1] 刘娟[1] 申林[1] 

机构地区：[1]第三军医大学新桥医院神经内科,重庆400037

出　　处：《局解手术学杂志》2017年第4期286-289,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨血管内支架成形术治疗颅外段颈内动脉夹层(ICAD)的临床效果。方法回顾性分析我院2015年7月至2016年12月收治的25例颅外段ICAD患者的临床资料,其中15例表现为头颈痛,12例出现短暂性脑缺血或者脑梗死表现(肢体偏瘫等),6例伴有Horner综合征,1例以搏动性耳鸣、晕厥首发,2例无明显临床症状,颈部血管超声偶然发现。25例ICAD患者均行血管内支架成形术治疗,通过数字减影血管造影(DSA)计算狭窄程度、经颅多普勒(TCD)测量血流速度以及观察患者临床表现,6个月后随访复查。结果 25例ICAD患者中24例血管内支架成形术顺利完成,未出现内膜损伤、出血、栓塞等并发症,1例血管走形迂曲,放弃支架置入;DSA显示平均动脉狭窄程度由术前的(76.70±10.57)%降至术后(即刻)的(11.07±4.18)%,差异有统计学意义(P<0.01);TCD测量颈内动脉狭窄段收缩峰值流速(PSV)由术前平均(189.55±54.27)cm/s降至术后(1周)平均(88.41±17.06)cm/s,差异有统计学意义(P<0.01);6个月后复查头颈部CT血管造影(CTA),与术后即刻比较,23例未见新的狭窄形成,1例出现支架内再狭窄;19例症状明显缓解或消失,4例部分缓解,1例复发,未出现梗死及其他严重并发症。结论血管内支架成形术是治疗颅外段ICAD相对安全、有效的方法,能有效改善狭窄程度、血流状况以及临床症状,且近期复发率低,不良反应较少,但不适用于血管严重迂曲患者。Objective To explore the clinic effect of intravascular stent angioplasty for extracranial internal carotid artery dissection （ICAD）. Methods From July 2015 to December 2016, 25 cases of patients with extracranial ICAD were admitted into our hospital. Among them, there were 15 cases of head and neck pain, 12 eases with transient ischemic or cerebral infarction symptoms （limb hemiplegia, etc. ） , 6 cases of Horner syndrome, 1 case with pulsatile tinnitus and syncope,2 cases with no obvious clinical symptoms which were found by the neck vascular ultrasound accidentally. All patients were treated with intravascular stent angioplasty. Calculated the degree of stenosis through digital subtraction angiography （DSA）, measured the blood flow velocity with transcranial doppler（ TCD ）, and observed the clinical manifestations. Reviewed those patients after six months. Results Totally 24 patients with ICAD fulfilled the intravascular stent angioplasty with no complications such as lining damage, bleeding and embolism. And one patient with ICAD abandoned intravascular stent angioplasty for the vascular is too circuity. DSA showed the average artery stenosis decreased from （76.70 ± 10.57 ）% preoperatively to （11.07 ± 4.18 ）% immediately after operation, and the difference was statistically significant （P 〈 0.01 ）. TCD measured the peak systolic velocity （PSV） of inter- nal carotid artery stenosis segment, and the PSV changed from （189.55 ＋ 54.27）cm/s averagely before operation to （88.41 ＋ 17.06）cm/s on average one week after operation. The difference was statistically significant （ P 〈 0.01 ）. Reviewed the head and neck CT angiography （CTA） after 6 months. There were 23 cases without new stenosis and 1 case had stent restenosis compared with CTA immediately after operation. Symptoms of 19 cases obviously remitted or disappeared,4 cases partially remitted, and recurrence occured in 1 patient. There was no appearance of infarction and other serious complications. Conclus

关 键 词：血管内支架成形术 颈内动脉夹层 脑缺血事件 血管迂曲 

分 类 号：R459.9[医药卫生—治疗学]