血管内支架植入术治疗缺血性脑血管病的临床报告

The application of endovascular stent-assisted angioplasty in patients with ischemic cerebral angiopathy

目的探讨血管内支架植入术治疗缺血性脑血管病的疗效、安全性及并发症。方法5例脑供血动脉狭窄分别为:颈动脉起始部狭窄1例、优势椎动脉开口部狭窄1例、优势椎动脉颅内段狭窄3例。行血管内支架植入术治疗。结果1例颅内段椎动脉狭窄的病例由于手术径路差,支架无法到位而中止手术,其余4例均获得技术上的成功,残余狭窄率小于10%。术中颈内动脉支架植入术患者出现一过性心率减慢,经使用阿托品后恢复正常,术后该患者48 h内出现血压下降,经使用多巴胺后血压逐渐恢复正常。1例椎动脉支架患者术后穿刺点部位出现假性动脉瘤,经局部压迫而治愈。所有患者均无手术相关的严重并发症出现。手术成功病例术后随访3个月无症状复发。结论对存在严重血管狭窄的缺血性脑卒中患者血管内支架植入术可能是有效的、安全性高的治疗方法。

Objective To study the efficacy, safety and complicated symptoms of endovascular stenting in the treatment of ischemic cerebral angiopathy. Methods Endovascular stenting was performed in 5 patients： one with stenosis at the beginning of left internal carotid, one with stenosis at the beginning of the dominant vertebral artery, and three with the stenosis in the in- tracranial segment of the dominant vertebral artery. Results The stent failed to reach the intracranial vertebral artery stenosis in 1 case, because of the tortuous path of the artery. Stenting was successful in the other 4 cases. Postoperative bradycardia and sequential hypotension in the case of internal carotid was corrected with drugs. False aneurysm at the site of puncture in one case of vertebral artery stenosis was cured by applying pressure dressing. No other serious comphcations occurred. Follow- up for 3 months showed smooth postoperative courses. Conclusion Endovascular stenting may be a safe and preferable choice of treatment for severe cerebral arterial stenosis.