支架成形术治疗主动脉弓上血管近端狭窄疗效初探  

Curative effect of angioplasty and stenting on proximal arcus aortae stenosis

作　　者：张荣举[1] 曹向宇[1] 杜志华[1] 刘新峰[1] 吕斌[1] 王君[1] ZHANG Rong-ju;CAO Xiang-yu;DU Zhi-hua;LIU Xin-feng;Lu Bin;WANG Jun(Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院第一医学中心神经内科

出　　处：《中国现代神经疾病杂志》2019年第10期760-765,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目(项目编号:81371296)~~

摘　　要：目的探讨支架成形术治疗主动脉弓上血管近端狭窄的手术方法与疗效。方法与结果2015 年1 月至2018 年6 月采用支架成形术共治疗13 例主动脉弓上血管近端狭窄患者,包括无名动脉狭窄5 例、右侧颈总动脉狭窄5 例、左侧颈总动脉狭窄3 例,共植入11 枚Express LD 球囊扩张支架、2 枚Wallstent自膨式支架。其中,4 例患者支架释放过程中未使用保护伞(无名动脉狭窄1 例、左侧颈总动脉狭窄3 例),术后3 d 1 例无名动脉狭窄患者MRI 显示皮质小梗死;术后6 个月1 例无名动脉狭窄患者CTA 显示支架内再狭窄(狭窄率> 50%)。结论支架成形术治疗无名动脉和颈总动脉起始部狭窄安全、有效,围手术期和远期疗效满意。术中需重点关注导引导管稳定性和保护伞回收问题。Objective To investigate the application of angioplasty and stenting in the treatment of proximal arcus aortae stenosis.Methods and Results From January 2015 to June 2018,13 patients with proximal stenosis of superior aortic arch including 5 patients with anonymous stenosis,5 patients with right common carotid artery(CCA) stenosis and 3 patients with left CCA stenosis were treated by stenting.Eleven Express LD balloon-expanding stents and 2 Wallstent self-expanding stents were implanted.No thrombus protective umbrella was used during stent release in 4 patients(one case of anonymous artery stenosis and 3 cases of left CCA stenosis).One case of anonymous artery stenosis showed small cortical infarction 3 d after operation.Six months after operation,CTA showed restenosis in stent in one case with anonymous artery stenosis.The restenosis rate was more than 50%.Conclusions Stenosis of anonymous artery and CCA can be treated by angioplasty and stenting.The stability of the guide catheter and the recovery of the filter devices should be considered during the operation.The perioperative and long-term results are satisfactory.

关 键 词：主动脉 胸 血管成形术 支架 血管造影术 数字减影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]