颈动脉支架成形术治疗重度颈动脉狭窄25例效果分析  

Carotid stent angioplasty for severe carotid artery stenosis: analysis of curative effect in 25 patients

作　　者：卫杰[1] 刘洁怡[1] 耿昌明[1] 孔晓东[1] 

机构地区：[1]上海解放军第85医院神经内科,200052

出　　处：《介入放射学杂志》2017年第4期359-363,共5页Journal of Interventional Radiology

摘　　要：目的评价颈动脉支架成形术(CAS)治疗重度颈动脉狭窄患者手术特点、安全性和围手术期处理。方法 2011年12月至2016年5月采用CAS术治疗25例颈动脉狭窄>85%患者,术中针对病变狭窄特点应用远端脑保护装置,注重个体化手术细节和围术期处理方案,观察血运重建、脑保护装置内脱落栓子情况,控制并发症发生。术后随访1年观察患者缺血性脑血管事件发生情况。结果 25例患者脑保护装置均通过重度狭窄后成功释放,球囊预扩张、支架释放后形态满意。北美症状性颈动脉内膜剥脱术试验研究(NASCET)方法检测显示,平均颈动脉狭窄程度由术前(91.0±3.1)%降至术后(21.0±5.1)%,保护伞均顺利回收,其中6个伞中发现脱落组织碎片。围术期未出现症状性脑出血、脑梗死、髙灌注综合征、死亡等严重事件。25例患者随访1年,无短暂性脑缺血发作、脑卒中、死亡发生。结论 CAS术治疗重度颈动脉狭窄患者时需注意术中个体化细节管理及围术期处理,选择合适的脑保护装置,以确保手术成功率和安全性。部分重度狭窄患者的术后疗效更直观而迅速。Objective To discuss the surgical characteristics, safety and perioperative management of carotid stent angiop]asty （CSA） for the treatment of severe carotid artery stenosis （〉85%）. Methods From December 2011 to May 2016, a total of 25 patients with carotid artery stenosis （〉85%） were treated with CSA. According to the stenotic characteristics of the lesion, distal cerebral protection device was employed in performing CSA. During the operation, attention was paid to individualized and detailed surgical management and perioperative management program; the revascularization and the dropping-off of thrombus in cerebral protection device were under close observation, while effort was made to control the occurrence of complications. The patients were followed up for one year to observe the occurrence of ischemic cerebrovascular events. Results The cerebral protection device was successfully deployed after it passed over the severe carotid artery stenosis. After balloon pre-dilation the stent was deployed, and the stent showed satisfactory shape. North America Symptomatic Carotid Endarterectomy Testing （NASCET） showed that the average degree of carotid artery stenosis was decreased from preoperative （91.0±3.1）% to postoperative （21.0±5.1）%. The protective umbrella was successfully retrieved in all patients, and deciduous tissue fragments were observed in 6 retrieved protective umbrellas. During the perioperative period no severe complications, such as cerebral hemorrhage, cerebral infarction, hyper-perfusion syndrome or death, were observed. All the 25 patients were followed up for one year, and no transient ischemic attack, stroke or death occurred. Conclusion In treating severe carotid artery stenosis with CSA, in order to ensure a successful surgery and patient＇s safety the following points are very important： in-operative individualized and detailed management, perioperative preventive measures, and use of appropriate cerebral protection device.

关 键 词：重度颈动脉狭窄 远端脑保护装置 颈动脉支架成形术 

分 类 号：R651.1[医药卫生—外科学]