心脑联合造影在颈动脉狭窄患者诊疗中的应用  

Application of combined angiography in diagnosis and treatment of carotid artery stenosis

作　　者：赵阳 金蔚涛 张玉坤 陈晓霖[2] 赵元立[2] 王嵘[2] 张文超 叶迅[2] 曾春[2] Zhao Yang;Jin Weitao;Zhang Yukun;Chen Xiaolin;Zhao Yuanli;Wang Rong;Zhang Wenchao;Ye Xun;Zeng Chun(Department of Neurosurgery,Peking University International Hospital,Beijing 102206,China;Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]北京大学国际医院神经外科,北京102206 [2]首都医科大学附属北京天坛医院神经外科,北京100070

出　　处：《中华医学杂志》2019年第39期3081-3084,共4页National Medical Journal of China

摘　　要：目的探讨心脑联合造影在颈动脉狭窄患者诊断治疗过程中安全性和临床价值。方法回顾性分析从2016年5月至2019年6月,在北京大学国际医院神经外科初诊颈动脉狭窄并接受心脑血管联合造影的患者,所有患者均在局麻下行联合造影,并根据造影结果及病史确定治疗方式,分析治疗期间患者并发症发生情况。结果共45例初诊颈动脉狭窄患者接受心脑联合造影,其中12例颈动脉无明显狭窄;22例为颈动脉单侧狭窄,其中轻度狭窄12例,中重度狭窄10例;11例为双侧狭窄,其中轻度狭窄3例,中重度狭窄8例。12例心脏血管无明显狭窄,11例心脏血管为单支病变,7例为2支病变,15例为3支病变。全组患者中共18例颈动脉狭窄存在手术指征,4例患者接受同期联合治疗,其中2例行颈动脉内膜剥脱术(CEA)+经皮冠状动脉介入治疗(PCI),2例行颈动脉支架植入术(CAS)+PCI。3例行CAS+冠状动脉造影,5例行CEA+冠状动脉造影,5例行联合造影后保守治疗,1例因为冠状动脉病变复杂,不建议其与颈动脉狭窄同期治疗,先行PCI。所有患者围手术期均无心肌梗死、脑梗死等心脏及脑血管相关并发症发生。结论心脑血管联合造影是颈动脉狭窄患者诊疗过程中评价心脑血管的良好方法,可以为治疗提供明确诊断,围手术期并发症发生率较低。Objective To evaluate the safety and clinical value of combined cardiac and cerebral angiography in the diagnosis and treatment of patients with carotid artery stenosis.Methods Clinical data of patients from May 2016 to June 2019 were collected.The patient underwent combined angiography under local anesthesia.Clinical characteristics,prognosisand complications were retrospectively analyzed.Results A total of 45 patients with carotid artery stenosis received combined angiography,among which 12 patients had no obvious carotid artery stenosis.There were 22 cases with unilateral carotid artery stenosis,including 12 cases with mild stenosis and 10 cases with moderate to severe stenosis.There were 11 cases of bilateral stenosis,including 3 cases with mild stenosis and 8 cases with moderate to severe stenosis.12 patients had no obvious stenosis incoronary arteries,11 patients had single-vessel disease,7 patients had 2-vessel disease,and 15 patients had 3-vessel disease.In the whole group of patients,surgical indications are available of 18 patients with carotid artery stenosis,4 of the mreceived combined therapy.2 of them under went Carotid Endarterectomy(CEA)+Percutaneous Transluminal Coronary Intervention(PCI),2 under went Carotid Artery Stenting(CAS)+PCI.CAS+coronary artery angiography was performed in 3 cases.CEA+coronary angiography was performed in 5 cases.5 patients received conservative treatment after combined angiography.In one case,the condition of coronary artery was so complicated that PCI was performed firstly.No cardiac or cerebrovascular complications such as myocardial infarction or cerebral infarction occurred during perioperative period.Conclusion Combined cardio-cerebrovascular angiography is a good method to evaluate the cardiovascular and cerebrovascular in the diagnosis and treatment of patients with carotid artery stenosis,which can provide a clear diagnosis for treatment with a low complications frequency.

关 键 词：联合造影 颈动脉狭窄 冠心病 

分 类 号：R54[医药卫生—心血管疾病]