经皮腔内血管支架成形术治疗颅内外血管狭窄16例

Percutaneous transluminal angioplasty (PTA) stenting for intracranial and extracranial artery stenosis of 16 cases

目的探讨经皮腔内血管支架成形术治疗颅内外血管狭窄。方法对16例颅内外脑血管狭窄的患者,由多学科参加进行术前评估后,行经皮腔内血管支架成形术治疗。结果16例患者中15例患者症状即刻消失或好转,术后残余狭窄率小于20%。其中1例因血管严重迂曲,支架无法到位,手术失败。1例因血压控制欠佳于术后48h出现高灌注综合征,继发颅内出血,经治疗后恢复良好。1例行颈内动脉支架植入术后出现持续低血压,经升压及补液对症治疗5d后血压正常。对15例患者术后随访3￣14个月,无患者发生再狭窄。结论经皮腔内血管支架成形术治疗颅内外血管狭窄创伤小、疗效好,但风险高,应注重术前评估、手术操作、并发症防治、围手术期监护及发挥团队协作精神。

[Objective] To investigate the effect of PTA stenting for intracranial and extracranial artery stenosis. [Methods] The procedure of PTA stenting for intracranial and extracranial artery stenosis was performed after the preoperative imaging of subjects in 16 cases. [Results] 15 patients＇ signs of 16 cases disappeared or changed better immediately. Immediate residual stenosis is below 20%. During these cases, one patient＇s stent couldn＇t go into the right position because of the bad path （which vein was serious convolute）, it was failing. Hyperperfusion syndrom occurred in one case after 48 hours because the blood pressure was beyond control. Intracranial bleeding appeared. He recovered after treatment. Continous hypotension occured in an intracranial artery stenosis. After stepping up the blood pressure, supplying fluid and heteropathy, the blood pressure got to normal level after 5 days. No one in the 15 cases restenosised following 3-14 months. [Conclusion] PTA stenting for intracranial and extracranial artery stenosis has low traumas, better efficacy, but high risk. We should pay attention to preoperative imaging, operation procedure, protected against complication, perioperative custodial care and carrying forward the spirit of community cooperation.