股腘动脉闭塞症的腔内治疗

Analysis of stroke after endovascular therapy of aortic expanded diseases

目的探讨主动脉夹层、主动脉瘤等主动脉扩张性疾病患者血管腔内治疗后脑卒中的发生原因及预防方法。方法对8例主动脉夹层、主动脉瘤患者血管腔内治疗后脑卒中患者的临床资料进行回顾性分析,其中1例为Stanford A型主动脉夹层,2例为Stanford B型主动脉夹层,2例为胸腹主动脉瘤,1例为胸主动脉瘤,1例为胸主动脉假性动脉瘤,1例为腹主动脉瘤。结果 8例患者均成功植入支架,其中5例在植入主动脉支架的同时封堵了左锁骨下动脉(LSA)开口。脑血管意外发生的平均时间为术后(2.50±2.00)天,6例发生脑梗死,2例脑出血,1例死亡。患者术前、术后的血压水平比较,差异具有统计学意义[收缩压:(132.80±10.99)mmHg vs(110.09±23.18)mmHg,P【0.05;舒张压:(74.21±3.86)mmHg vs(60.17±12.93)mmHg,P【0.05]。2例脑出血的患者术中均使用超过6000 U肝素。结论术前、术后血压水平差异过大、对LSA盲目进行封堵、肝素用量过大、腔内操作不熟练等是导致主动脉疾病血管腔内治疗术后脑卒中的主要因素。

Objective To analysis the reasons and propose the preventions of stroke after endovascular therapy of aortic expanded diseases. Methods During the last decade, 8 cases of stroke after endovascular therapy of aortic expanded diseases were included, among which 3 were aortic dissection and the others were diagnosed as aortic aneurysm or pseudoaneurysm. Results Stent grafts were successful implanted in all cases, while 62.50% of them had the hatch of LSA covered. 75% of the cases were cerebral infarction and 25% were cerebral hemorrhage. The level of blood pressure between pre-operation and post-operation was different significantly [systolic pressure:(132.80±10.99) mmHg vs(110.09±23.18) mmHg, P<0.05; diastolic pressure:(74.21±3.86)mmHg vs(60.17±12.93) mmHg, P <0.05)]. All cases suffered from cerebral hemorrhage had used large dose of heparin during the operation. Conclusion Significant decrease of blood pressure, large dose of heparin and unpractised operation of endovascular technique are reasons causing stroke after endovascular therapy of aortic expanded diseases.