滤网保护系统在颈动脉支架置入术中应用的早期经验(附4例报告)  

Early experience of carotid artery stenting with distal filtration device--4 cases report

作　　者：罗建方 周颖玲[1] 陈纪言[1] 王丽娟[2] 王硕[2] 李瑜辉[1] 黄文辉[1] 谭宁[1] 李光[1] 

机构地区：[1]广东省心血管病研究所心内科,广州市510100 [2]广东省人民医院神经内科

出　　处：《中国介入心脏病学杂志》2003年第1期13-15,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的　评估在颈动脉支架植入术 (carotidarterystenting,CAS)中应用滤网保护系统 (An gioguardXP)的可行性和安全性。方法　从 2 0 0 2年 6月到 7月 ,共对 4名男性患者的 4个病变进行了滤网系统 (AngioguardXP ,Cordis)保护下的CAS ,入选条件为颈动脉靶病变狭窄≥ 70 % ,且无CAS及滤网放置禁忌证。手术前后按现标准服药及常规处理 ,CAS及滤网放置和回收均按照标准方法进行 ,采用镍钛合金的自膨式支架 (Smart,Cordis) ,技术成功包括血管造影和装置使用成功。所有病人在术前和术后 2 4h均接受神经内科医生的NIHSS评分 ,完整地评估神经专科的情况。对术后所有病人进行心脑血管事件及死亡等临床终点的随访。结果　患者平均年龄为 (5 9± 4)岁 ,除 1例曾有一过性脑缺血发作外 ,其余均无脑卒中史 ;各有 1例分别患有糖尿病及高血压病 ;1例有心肌梗死病史并在CAS前 1周行冠状动脉介入治疗。靶病变平均狭窄程度为 (82± 6 ) % ,其中左颈内动脉 (leftinternalcarotid ,LICA)及右颈内动脉 (rightinternalcarotid ,RICA)病变各有 2个。分别对以上 4个病变成功置入了 4枚自膨式支架及放置回收了 4个滤网保护系统 ,技术成功率为 10 0 % ;无围术期的心脑血管事件发生。在回收的 4个滤网中均发现 6～ 10个直径为 30Objective The purpose of this study was to assess the effectiveness and safety of distal filtration protection devices during carotid artery stenting.Methods Between June and July in 2002, carotid artery stenting (CAS) were performed in 4 patients with asymptomatic severe carotid artery stenosis. Self-expendable stents (Smart, Cordis) and distal filtration devices (Angioguard XP, Cordis) were used in all patients. Primary endpoints were perioperative neurologic complications and mortality. Data were collected prospectively.Results All patients were male, their age were 59±4 years old. One patient had history of transient ischemic attacks(TIAs); and another had inferior myocardial infarction, and right coronary intervention was performed before CAS, and another one underwent CABG 6 months ago. There were two right internal carotid and two left internal carotid severe lesions (82.5±6.0)% were treated. The filtration devices and stents were delivered and deployed successfully in all target artery (technical success rate was 100%) and <10% residual stenosis post-procedure. The overall combined end point of all neurologic deficits and death were not found in these patients. The particles were found in the filters in all cases. Particles analysis showed that there were umbers of particles in 300-400 micron of diameter in the filter baskets. Conclusion Our early experience has shown that distal filter protection during carotid artery stenting is technically feasible and appears to be effective in preventing procedure-related neurologic complications.

关 键 词：滤网保护系统 颈动脉支架置入术 应用 早期经验 病例报告 

分 类 号：R543.4[医药卫生—心血管疾病] R815[医药卫生—内科学]