老年颅外段颈动脉狭窄患者的血管内介入治疗及相关问题的探讨

The discussion about endovascular interventional treatment for extracranial carotid stenosis and related questions in aged patients

目的 探讨老年 (≥ 70岁 )颅外段颈动脉狭窄患者经皮血管内支架成形术 (PTAS)的适应证、手术方法及围手术期处理等相关问题。方法 本组收集 16例老年颅外段颈动脉狭窄患者经全脑数字减影血管造影 (DSA)检查诊断后 ,均采用经股动脉入路应用自膨式支架行PTAS治疗。结果 16例颅外段颈动脉狭窄患者术后狭窄段的直径较术前扩大 ,12例达到正常管径的 6 0 %以上 ,4例达到 4 0 % ,有症状的 14例术后临床脑缺血症状和体征明显改善。全部患者无并发症发生。随访 2～ 2 4个月 ,全部患者均未再发生脑缺血 ,其中 2例行DSA复查、6例行多普勒超声复查 ,均无再狭窄发生。结论 PTAS是治疗老年颅外段颈动脉狭窄的简便安全有效方法之一。

Objective To discuss the questions about indication, operation method and the management during operation of percutaneous transluminal angioplasty and stenting (PTAS) in the aged(≥70 years old) with extracranial carotid stenosis.Method Sixteen cases were diagnosed by digital subtract angiography (DSA) and received PTAS with self-expand stent by the approach of femoral artery.Results The postoperative caliber of the stenotic segment was larger than the preoperative caliber, and increased by over 60% of the normal caliber in 12 cases and over 40% in 4 cases. The clinical symptoms and signs of ischemia were improved obviously after PTAS in 14 cases with ischemia. No complication occurred in the group. During the follow-up for 2～24 months no cerebral ischemic attack occurred in all the cases and no restenosis was found in follow-up examination by DSA in 2 cases and by Doppler in 6 cases.Conclusion PTAS is an easy and safe therapy for aged patients with extracranial carotid stenosis.