Management of cerebral ischemia due to Takayasu's arteritis  

大动脉炎所致的脑缺血的治疗

作　　者：汪忠镐[1,2] 余军 谷涌泉 王世华 吴济东 李国兴 沈来根[3] 汪忠镐[1,2] 李鸣[2] 潘松林[2] 张鸿坤[2] 金炜[2] 管珩[4] 吴庆华 张小明 

机构地区：[1]北京邮电医院血管外科,北京100032 [2]浙江大学医学院血管外科研究所,杭州310003 [3]浙江大学医学院附属第一医院血管外科,杭州310003 [4]北京协和医院外科,北京100730 [5]北京安贞医院血管外科,北京100029 [6]北京大学第三临床医学院血管外科,北京100044

出　　处：《Chinese Medical Journal》2002年第3期342-346,共5页中华医学杂志（英文版）

摘　　要：OBJECTIVE: To explore the management of cerebral ischemia caused by Takayasu's arteritis. METHODS: Ninety-three cases treated from June 1984 to September 1999 at the General Post & Telecom Hospital, the Sir Run Run Shaw Hospital, the First Affiliated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hospital, including 10 men and 83 women, were reviewed. Of the 93 cases, bypasses from the ascending aorta to the axillary or subclavian artery and from graft to the carotid artery were performed in 47 cases. Subclavian to carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in five cases and stenting in one. RESULTS: Marked improvement was achieved in 30.3%, fair in 34.9%, improvement in 21.2%, unchanged in 4.6%, and death in 9.0% before discharge; 30.6%, 38.8%, 16.3%, 4.1%, and 2.0% respectively during a mean follow-up of 48 months, and recurrence requiring revision in 8.2%. CONCLUSION: Patients with occlusive lesions of all four cervical arteries always have severe cerebral ischemia and their distal runoff is always unvisualised by angiography. However, we found by exploration that the internal carotid artery is patent in all but one patient. Therefore, an ascending aorta to carotid bypass is feasible in most instances, and this can and should be done when the cerebral perfusion is jeopardized at a time when the patient is in a stable or relatively stable condition. Unfortunately, the cerebral re-perfusion syndrome is still a serious and not completely solved problem.目的　探讨由大动脉炎所致的脑缺血的外科治疗。方法　本文报导了我们自 1984年 6月至 1999年 9月治疗 93例因头臂型大动脉炎 (TA)所致脑缺血的临床经验。其中 ,男性 10例 ,女性 83例 ,升主动脉 -腋动脉或锁骨下动脉 -颈动脉搭桥 4 7例 ;锁骨下动脉 -颈动脉搭桥 7例 ;经皮腔内球囊成形 (PTA) 5例 ;合并支架置放术 1例。结果　显效 30 3% ,有效 34 9% ,改善 2 1 2 % ,无效 4 6 % ,死亡 9 0 % ;平均 4 8个月随访疗效分别为 :30 6 % ,38 8% ,16 3% ,4 1%和 2 0 % ;复发 8 2 %。结论　当脑供血不足时 ,于病情相对稳定阶段 ,应以积极正确的方法予以治疗。如有可能 ,PTA可作为首选 ,但术后易复发。据我们的经验 ,颈部四血管阻塞性病变在造影时多不能显示远端流出道。但升主动脉 -颈动脉搭桥在绝大多数情况下是可行的。然而 ,术后脑组织再灌注损伤至今仍未能完全解决。

关 键 词：Adolescent Adult Angioplasty  Balloon Brain Ischemia Child Female Humans Male Middle Aged PHYTOTHERAPY Plant Preparations Takayasu's Arteritis TRIPTERYGIUM 

分 类 号：R743[医药卫生—神经病学与精神病学]