逆向血流保护下经颈动脉支架成形术临床应用三例观察  

Clinical application of three cases of transcarotid artery revascularization

作　　者：曲乐丰 柏骏 Jeffrey Jim 金杰 吴鉴今 Qu Lefeng;Bai Jun;Jeffrey Jim;Jin Jie;Wu Jianjin(Department of Vascular and Endovascular Surgery,Changzheng Hospital,Second Military Medical University,Shanghai 200003,China;Department of Vascular Surgery,Washington University in St.Louis School of Medical,Missouri,St.Louis,63101,USA)

机构地区：[1]海军军医大学第二附属医院血管外科,上海200003 [2]华盛顿大学圣路易斯医学院血管外科,美国密苏里州63101

出　　处：《中华医学杂志》2020年第13期978-982,共5页National Medical Journal of China

基　　金：国家自然科学基金面上项目(8187020187)。

摘　　要：目的探讨逆向血流保护下经颈动脉支架成形术(TCAR)治疗颈动脉狭窄的手术指征、术前评估、技术要点、围术期处理及疗效。方法收集2019年3至4月海军军医大学第二附属医院接受TCAR治疗的颈动脉狭窄患者3例,以颈总动脉入路,在颈动脉-股静脉逆向血流保护下,行颈内动脉狭窄的支架成形术,达到解除狭窄、重建血运的目的。详细记录患者一般情况、术前评估、术中操作、术后处理、并发症及随访情况,评价TCAR治疗颈动脉狭窄的临床安全性、有效性及疗效。结果手术均获得成功,其中行左侧TCAR 2例,右侧TCAR 1例。共植入颈动脉支架3枚,手术时间分别为65、59、55 min,腔内操作时间分别为13、18、11 min,颈总动脉阻断血液逆流时间分别为15、20、13 min,对比剂使用剂量分别为20、25、15 ml。围术期无死亡病例,无神经系统及其他相关并发症。3例患者分别随访7、7、6个月,无死亡病例,无神经系统及其他相关并发症,所有患者颈动脉支架通畅。结论TCAR采用经颈动脉入路,颈动脉-股静脉持续逆向血流的脑保护系统可有效预防围术期短暂性脑缺血发作(TIA)及卒中发生,是颈动脉狭窄安全、有效的治疗方式。Objective To investigate the surgical indications,preoperative evaluation,technical points,perioperative management and effect of transcarotid artery revascularization(TCAR)in the treatment of carotid stenosis.Methods From March to April 2019,three patients with carotid stenosis undergoing TCAR in the Second Affiliated Hospital of Naval Military Medical University.With the common carotid artery approach,under the protection of the carotid-femoral vein reverse blood flow,the balloon dilatation of the internal carotid artery stenosis and stent implantation to achieve the purpose of carotid revascularization.The patient′s general condition,preoperative evaluation,intraoperative operation,postoperative management and complications were recorded in detail.The clinical safety,efficacy and efficacy of TCAR in the treatment of carotid stenosis were evaluated.Results All three operations were successful,including 2 cases of left carotid artery revascularization and 1 case of right carotid artery revascularization.A total of 3 carotid stents were implanted.The operation time was 65,59,and 55 min,the intraluminal operation time was 13,18,and 11 min,the common carotid artery blocked time was 15,20,and 13 min,the contrast agent was 20,25,15 ml,respectively.There was no death,no nervous system and other related complications during the perioperative period.Three patients were followed up for 7,7,and 6 months without death,there were no nervous system diseases and other complications.All patients with ultrasound indicated that the carotid artery stent was patency.Conclusion TCAR adopts the neuroprotection system of carotid-femoral vein continuous reverse blood flow to prevent transient ischemic attack(TIA)and stroke,and it is a safe and effective treatment for carotid artery stenosis.

关 键 词：颈动脉狭窄 脑保护装置 逆向血流保护下经颈动脉支架成形术 

分 类 号：R651[医药卫生—外科学] R74[医药卫生—临床医学]