经皮血管内支架成形术在颅内血管疾病的初步应用  

Experience with transluminal stent-assisted angioplasty for intracranial vascular diseases

作　　者：缪中荣[1] 凌锋[1] 李慎茂[1] 朱凤水[1] 王默力[1] 张鸿祺[1] 华扬[1] 宋庆斌[1] 

机构地区：[1]首都医科大学北京宣武医院神经外科,100053

出　　处：《中华外科杂志》2002年第12期886-889,I001,共5页Chinese Journal of Surgery

摘　　要：目的　探讨支架置入技术在治疗颅内血管疾病中的应用价值。　方法　回顾性分析了13例成功置入支架的手术经验 ,探讨颅内支架置入的适应证、技术可行性及并发症的预防。 13例颅内血管病变包括有症状的颅内血管狭窄患者 7例 ,其中大脑中动脉狭窄 3例 ,颈内动脉床突上段狭窄1例 ,椎动脉颅内段狭窄 3例 ;颅内宽颈动脉瘤 5例 ,包括 1例基底动脉起始段宽颈动脉瘤 ,2例海绵窦段巨大宽颈动脉瘤以及 2例颈动脉 海绵窦瘘栓塞后海绵窦段宽颈假性动脉瘤 ;静脉窦狭窄 1例。结果　 7例有症状的颅内血管狭窄患者在支架置入后狭窄血管明显扩张 ,从原来平均狭窄 83%下降到 5 %,其中 1例出现了与技术有关的并发症。 5例宽颈动脉瘤患者 (包括 2例假性动脉瘤 )通过支架辅助成功地达到了囊内栓塞。横窦狭窄患者在其一侧置入支架后 ,颅内压力明显下降 ,临床症状减轻 ,8个月后随访症状完全消失。　结论　支架置入血管内成形技术 ,可以成功地应用于颅内血管疾病的治疗 ,但对于适应证的选择和长期的疗效有待于进一步的观察确定。Objective To assess the value of stent-assistant angiopasty for intracranial vascular diseases. Methods Thirteen patients with intracranial vascular diseases were treated consecutively by stent-assistant angioplasty for different purposes. Of these patients 7 had symptomatic intracranial artery stenosis, 3 intracranial wide-neck aneurysms, 2 intracranial pseudoaneurysms, and 1 bilateral transverse sinus stenosis. Clinical procedures and technical data of the patients were retrospectively analyzed. Results In the 7 patients, the degree of intracranial artery stenosis reduced from 83% to 5%. Three months after the operation they exhibited good patency of stented lesions. Intracranial wide neck aneurysms(with 2 pseudoaneurysms) were successfully embolized with GDC in 5 patients. The patients with bilateral transverse sinus stenosis were implanted a self-expanded stent in the right transverse sinus. One patient failed because of the tortuous configuration of the left jugular bulb, but the patient′s symptoms were improved quickly after the procedure. Conclusion Stent-assistant angioplasty is a useful technique for selected intracranial vascular diseases, and it needs further investigation.

关 键 词：经皮血管内支架成形术 脑动脉疾病 脑动脉瘤 脑血管疾病 适应证 并发症 

分 类 号：R651.1[医药卫生—外科学]