颈动脉狭窄的DSA诊断与血管内介入治疗

DSA diagnosis and percutaneous transluminal stenting of carotid artery stenosis

目的 探讨颈动脉狭窄的血管内介入诊疗价值。方法 回顾性分析 14 2例颈动脉狭窄患者的血管内介入诊疗资料。结果 DSA检查均能获得明确的诊断。颈动脉造影显示全部患者颈动脉均有不同程度的狭窄 ,其中面积狭窄百分比≤ 5 0 %者 2 6例 ,狭窄程度 >5 0 %而≤ 70 %者 66例 ,狭窄程度 >70 %者 5 0例。 3 8例颈动脉狭窄患者拟行血管内支架者 ,3 7例成功地置入了血管内支架 ,即刻DSA显示狭窄程度由术前的 78.7% ( 64 %～ 10 0 % )下降到约 3 2 .4% ( 0～ 5 8% )。结论 血管内介入技术在颈动脉狭窄的诊断与治疗中具有重要价值。

Objective To make a further understanding of DSA appearances of the stenosis of carotid artery, and to assess feasibility and efficacy of percutaneous transluminal stenting for the stenosis of carotid artery. Methods The data of 142 patients with stenosis of carotid artery underwent selective DSA and percutaneous transluminal stenting were analyzed retrospectively. Results All patients were diagnosed correctly. Carotid angiogram demonstrated that the degree of the stenosis was less than 50% in 26 patients,50%-70% in 66 cases,and greater than 70% in 50 patients. The narrowing segments were in the common carotid artery in 14 patients and in the internal carotid artery in 128 patients. The lengths of the stenosis were from 8 to 65 mm. Stent placement was performed in 38 cases, and 37 cases were successful. In one patient, the narrowing lumen could not be crossed with a guidewire because of severe stenosis and tortuous vessel. The immediate DSA demonstrated that the average degree of stenosis of 78.7% (64%-100%) before stent placement was reduced to an average of 32.4% (0-58%) after this procedure. During a mean follow up period of 6 months, there was no case of TIA or cerebral infarction. Conclusion DSA is one of the ideal and reliable diagnostic methods, and is helpful in assessing the prognosis and working out the therapy plan for the carotid artery stenosis. Percutaneous transluminal stenting for patients with carotid artery stenosis is an effective and safe therapeutic method with few and acceptable complications.