以脑缺血为主要症状的主动脉弓上血管狭窄性病变的介入治疗

Interventional Treatment for Occlusive Lesions in Supra-arch Vessels with Brain Ischemic Symptoms

目的 探讨以脑缺血为主要症状的主动脉弓上血管狭窄性病变的介入治疗效果.方法 52例患者的共56处主动脉弓上狭窄性病变接受了血管腔内治疗,其中锁骨下动脉狭窄22处,锁骨下动脉闭塞14处,颈内动脉狭窄12处,无名动脉狭窄8处.病变的狭窄程度均大于60%（65%～100%）.所有患者均表现出脑缺血的症状,如头痛、头晕、发作性肢体无力、黑朦等,其中部分患者锁骨下动脉和无名动脉病变的病例还同时伴有上肢缺血症状.56处病变中,单纯行血管扩张术15例、放置支架39例,有2例锁骨下动脉闭塞的病例因闭塞段坚硬无法打通而改行外科手术治疗.4例颈内动脉狭窄的病例在支架放置过程中使用了保护伞装置.11例锁骨下动脉闭塞病变由于顺行打通比较困难,采用经股动脉和肱动脉联合入路进行治疗.结果 手术技术成功率为96.4%（54/56）,成型后血管残余狭窄均小于30%.所有患者的临床症状均明显改善.发生手术相关并发症3例,占所有接受治疗患者的5.8%（3/52）,无死亡病例.随访46例,随访率88%,平均随访时间24个月,无死亡及严重脑卒中发生.有2例只接受经皮血管腔内成型术治疗的患者发生术后再狭窄.结论 对于以脑缺血为主要症状的主动脉弓上血管狭窄性病变,血管成型术和/或支架置入术是安全有效的治疗方法.

Objective To evaluate the therapeutic effect of percutaneous transluminal angioplasty and stenting for occlusive lesions in supra-arch vessels with brain ischemic symptoms. Methods A total of 56 occlusive lesions of the innominate, subclavian, and internal carotid arteries were treated with angioplasty and intravascular stent placement in 52 patients. The degree leading of stenosis was more than 60% in all patients and the symptom was brain ischemia. In 11 patients, the occluded subclavian artery could not be crossed via the femoral route, therefore the brachial route was used and the occlusion was crossed in a retrograde fashion. Results Technical success was achieved in 54 of 56 procedures （96.4%）. Residual stenosis was less than 30% in all cases. The clinical symptoms improved after procedure in all patients. Complications occurred in 3 of 52 （5.8%） procedures, follow-up period （ means 24 and the 30-day mortality rate was 0. There were no death and severe stroke in the months）. Restenosis was observed in 2 patients after percutaneous transluminalangioplasty treatment. Conclusion Percutaneous transluminal angioplasty with or without stenting is a safe and valid choice for treatment of occlusive lesions of supra-arch vessels in patients with cerebral ischemic symptoms.