非急性期症状性长节段颈内动脉闭塞开通术初步经验  

Preliminary experience of endovascular recanalization for non-acute symptomatic long segment internal carotid artery occlusion

作　　者：伍振富[1] 李冰华[1] 黎冠东[1] 刘根 陈钜涛 WU Zhenfu;LI Binghua;LI Guandong;LIU Gen;CHEN Jutao(Jiangmen Central Hospital,Jiangmen 529000,China)

机构地区：[1]江门市中心医院,广东江门529000

出　　处：《中国实用神经疾病杂志》2020年第17期1490-1496,共7页Chinese Journal of Practical Nervous Diseases

基　　金：江门市医疗卫生领域科技计划项目(编号:2019020100490003656)。

摘　　要：目的探讨血管内治疗非急性期症状性长节段颈内动脉闭塞的临床疗效及安全性。方法回顾江门市中心医院2017-07—2019-06采用血管内治疗非急性期症状性长节段颈内动脉闭塞的10例患者的临床资料,采用美国国立卫生研究院卒中量表(NIHSS)、蒙特利尔认知评估量表(MoCA)、改良Rankin量表(mRS)等综合评估临床效果及安全性。结果10例患者共11条闭塞的颈内动脉均成功开通。10例患者中1例术后出现脑出血病情加重,经治疗后好转;1例术中出现颈动脉夹层,经支架覆盖后夹层消失;1例开通的颈内动脉1周后再次闭塞症状,症状无加重;1例术后1 a开通的颈内动脉C1段支架内再狭窄,经球囊扩张后狭窄明显改善;其余6例未发现并发症。10例患者术前NIHSS评分(6.4±4.6)分,术后90 d为(3.2±2.2)分,两者差异有统计学意义(t=2.4337,P=0.0378)。10例患者术后90 d MoCA评分(22.2±5.2)较术前(18.8±4.4)增加(t=3.3556,P=0.0084)。术后90 d随访mRS 0~2分7例(良好预后率70%)。结论初步应用血管内治疗非急性期慢性长节段颈内动脉闭塞安全有效,术后神经功能障碍及认知障碍明显恢复,远期疗效有待进一步观察。Objective To investigate the clinical effect and safe of endovascular recanalization in non-acute symptomatic long segment internal carotid artery occlusion.Methods Ten patients with non-acute symptomatic long segment internal carotid artery occlusion treated wiht endovascular recanalization at Jiangmen Central Hospital from July 2017 to June 2019 were analyzed retrospectively.The effect and safe were evaluated by the National Institutes of Health stroke scale(NIHSS)scores,the Montreal cognitive assessment(MoCA),the modified Rankin scale(mRS).Results All of the eleven occluded arteries in 10 patients achieved successful recanalization.Of all the ten patients,one had intracranial hemorrhage and symptoms became aggravated,and it improved after treatment;one had carotid dissection and it disappeared after carotid stenting;one had occlusion again one week after operation,but had no other symptoms;one had carotid stenosis in stent of carotid segment one after recanalization one year,and it improved after ballon dilatation,and the left six patients had no complication.The NIHSS of patients was(6.4±4.6)before operation,and(3.2±2.2)after 90 days of operation,and there was significant difference between the two scores(t=2.4337,P=0.0378).Compared to the MoCA of(18.8±4.4)before operation,it increased to(22.2±5.2)after 90 days of operation(t=3.3556,P=0.0084).The clinical follow-up results at 90 days showed that seven patients had a mRS score of 0-2(good prognosis rate is 70%).Conclusion Endovascular recanalization is safe and effective for non-acute symptomatic long segment internal carotid artery occlusion,neurologic deficit and cognitive dysfunction were improve post-operation,and the long-term effect needs further study.

关 键 词：颈内动脉闭塞 脑梗死 颈动脉夹层 血管内治疗 支架 再狭窄 认知障碍 

分 类 号：R543.4[医药卫生—心血管疾病]