慢性颈内动脉闭塞患者复合手术治疗中应用Supera支架的安全性和可行性分析  

Safety and feasibility of Supera stent in combined surgical treatment of patients with chronic internal carotid artery occlusion

作　　者：文朋 李龙[1] 张银行 杨斌[1] 朱凤水[1] 陈健[1] 华扬[3] 程登贵 邓昭健 焦力群[1] Wen Peng;Li Long;Zhang Yinhang;Yang Bin;Zhu Fengshui;Chen Jian;Hua Yang;Cheng Denggui;Deng Zhaojian;Jiao Liqun(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;不详)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]贵州省遵义市第一人民医院神经外科,563099 [3]首都医科大学宣武医院血管超声科,北京100053

出　　处：《中国脑血管病杂志》2022年第7期484-489,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨Supera支架治疗慢性颈内动脉闭塞的安全性及可行性。方法回顾性分析2019年3月至2020年7月首都医科大学宣武医院神经外科连续收治的12例慢性颈内动脉闭塞患者的临床资料,患者均为男性,单独使用Supera支架和(或)联合其他支架行复合手术。记录患者的一般资料,包括年龄、性别、病史、临床症状、心脑血管病危险因素等。疗效评价指标包括支架释放成功、术后即刻血管再通成功[改良脑梗死溶栓(mTICI)分级3级]、出院时改良Rankin量表(mRS)评分,安全性评价指标包括术中及术后并发症(支架内血栓、脑梗死、脑出血、脑水肿、切口感染、切口血肿、心脏事件)。术后3个月采用电话及门诊面对面的方式对患者进行影像学和临床随访,影像学随访包括颈动脉超声或CT血管成像或DSA,以最后一次影像资料结果为准,若病变段狭窄率>50%,则认为发生再狭窄(中度狭窄:狭窄率为>50%~69%,重度狭窄:狭窄率为70%~99%);临床随访包括前循环缺血性卒中、mRS评分及死亡事件。结果12例慢性颈内动脉闭塞患者平均年龄(64±6)岁。临床表现包括肢体无力8例,单侧眼盲2例,言语功能障碍8例,反复短暂性脑缺血发作1例。术前mRS评分0~2分10例,3分2例。12例慢性颈内动脉闭塞患者均成功置入支架,术后即刻均达成功再通(mTICI分级3级)。出院时mRS评分0~2分11例,3分1例。术后发生无症状性新发脑梗死5例,未发生其他并发症。术后随访5~21个月,mRS评分0~2分12例;8例患者颈内动脉通畅,4例患者发生颈内动脉再狭窄,包括中度狭窄2例(无临床症状),重度狭窄2例(肢体无力1例、语言功能障碍1例)。无死亡患者。结论初步分析提示,Supera支架可尝试用于治疗慢性颈内动脉闭塞,但仍需增加样本量及开展长期有效性研究进一步探讨。Objective To explore the safety and feasibility of Supera stent in the treatment of chronic internal carotid artery occlusion(ICAO).Methods The clinical data of 12 patients with chronic ICAO treated in the Department of Neurosurgery of Xuanwu Hospital,Capital Medical University from March 2019 to July 2020 were retrospectively included.All were male patients and were treated with Supera stent alone or combined with other stents.General information of the patients,including age,sex,medical history,clinical symptoms,the risk factors of cerebrovascular disease,etc.The efficacy evaluation indicators included the success of stent release and immediate postoperative vascular recanalization(modified thrombolysis in cerebral infarction[mTICI]grade 3)and the modified Rankin scale(mRS)score at discharge.The safety evaluation indicators included intraoperative and postoperative complications(in-stent thrombosis,cerebral infarction,cerebral hemorrhage,brain edema,incision infection,incision hematoma,cardiac events).After three months of the operation,the patients were followed up by the telephone and face-to-face visit in outpatient clinic.Imaging follow-up included carotid ultrasound,CT angiography or DSA.The last result was used as the diagnostic standard.Restenosis was defined as the stenosis rate of the lesion>50%(moderate stenosis:stenosis rate ranging 50%to 69%;severe stenosis:stenosis rate ranging 70%to 99%).Clinical follow-up included anterior circulation ischemic stroke,mRS score and death events.Results The average age of all the 12 patients with chronic ICAO were(64±6)years.Clinical manifestations included limb weakness in 8 cases,unilateral blindness in 2 cases,speech dysfunction in 8 cases,and recurrent transient ischemic attack in 1 case.Preoperative mRS scores were 0 to 2 in 10 cases and 3 in 2 cases.Stents were successfully implanted in 12 patients with chronic ICAO,and successful recanalization was achieved immediately after operation(mTICI grade 3).At discharge,11 cases had mRS score 0-2,and 1 case had 3.T

关 键 词：动脉闭塞性疾病 Supera支架 颈内动脉闭塞 杂交手术 治疗结果 

分 类 号：R651.12[医药卫生—外科学]