腔内治疗自发性颈动脉夹层合并缺血性脑卒中的分析  

Analysis of the endovascular treatment of spontaneous carotid artery occlusion combined with ischemic stroke

作　　者：周保宁 化召辉[1] 单金涛 杜世昌 薛文豪 夏磊[1] 罗云鹏 柴一鸣 李震[1] Zhou Baoning;Hua Zhaohui;Shan Jintao;Du Shichang;Xue Wenhao;Xia Lei;Luo Yunpeng;Chai Yiming;Li Zhen(Department of Endovascular Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院腔内血管外科,河南郑州450052

出　　处：《中国血管外科杂志（电子版）》2024年第1期46-50,共5页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：国家自然科学基金面上项目(82370503)。

摘　　要：目的探讨腔内技术在治疗自发性颈动脉夹层合并缺血性脑卒中患者的应用和疗效。方法回顾性分析2018年6月至2023年6月郑州大学第一附属医院利用腔内技术治疗的35例自发性颈动脉夹层合并缺血性脑卒中患者临床资料,统计患者住院及随访期间脑缺血和脑出血事件发生率、支架通畅率和死亡率等。结果手术成功率100%。围手术期发生远端栓塞1例,发生蛛网膜下腔出血1例,均经保守治疗后复良好;发生无症状性支架内闭塞2例;死亡1例,因脑出血继发脑水肿、脑疝死亡,死亡率为2.86%。患者随访6~60个月,平均(27.62±14.80)个月,发生无症状性支架内狭窄1例,1例患者因远端残余夹层动脉瘤形成行二次手术。患者均无脑缺血及死亡事件发生。结论腔内技术用于治疗自发性颈动脉夹层合并缺血性脑卒中患者成功率高,安全性较好,围手术期并发症发生率低。Objective To explore the application and efficacy of endovascular techniques in the treatment of spontaneous carotid artery dissections combined with ischemic stroke.Methods The clinical data of 35 patients with spontaneous carotid artery dissections combined with ischemic stroke treated with endovascular techniques from June 2018 to June 2023 by the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.The rates of cerebral ischemic and cerebral hemorrhage events,stent patency rate and mortality rate during the hospitalization and follow-up period were counted.Results The success rate of the procedure was 100%.One case occurred distal embolism and subarachnoid hemorrhage in the perioperative period,respectively,and both recovered well after conservative treatment.Two cases of asymptomatic in-stent occlusion occurred during the perioperative period.One case died due to cerebral hernia secondary to cerebral hemorrhage and cerebral edema,with a mortality rate of 2.86%.Patients were followed-up for 6-60 months,with a mean time of 27.62±14.80 months.One case occurred asymptomatic in-stent stenosis during the follow-up period,and one patient underwent a second operation for distal residual dissection aneurysm formation.No patient had ischemic events or deaths during the follow-up period.Conclusion Endovascular techniques for spontaneous carotid artery dissections combined with ischemic stroke have a high success rate,good safety and low rate of perioperative complications.

关 键 词：颈动脉 夹层 缺血性脑卒中 支架植入术 腔内手术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]