胸主动脉疾病腔内修复术后并发缺血性脑卒中及其防治探讨

Ischemic stroke occuring after endovascular thoracic aortic repair and its prevention

目的：回顾性分析胸主动脉疾病腔内修复术后并发缺血性脑卒中的影响因素、临床特点、相关愈后及预防措施。方法：回顾性分析本院自1999年至2006年6例胸主动脉疾病腔内修复术后并发缺血性脑卒中的病例,分析其治疗经过和结果,总结其主要原因及预防措施。结果：在6例发生缺血性脑卒中的病人中,有Stanford B型主动脉夹层动脉瘤5例,胸降主动脉瘤1例；空气栓塞1例,主动脉弓粥样硬化斑块脱落、栓塞2例,与术中控制性降压或低血压时间过长有关者3例；死亡3例,另3例治愈出院者均遗留不同程度的神经系统症状。结论：胸主动脉疾病腔内修复术后并发缺血性脑卒中,虽发生率较低,但后果严重,预后不佳。在以后工作中,需进一步总结经验,严格规范介入操作技术,积极改进相关医疗器械,以逐渐减少卒中的发生率。

Objective To review the clinical features and risk factors of ischemic stroke occuring after endovascular thoracic aortic repair, as well as the outcome of patients and its prevention strategies. Methods The clinical data of 6 patients with ischemic stroke occuring after endovascular thoracic aortic repair, during the period from 1999 to 2006 were retrospectively analyzed. The causes and prevention strategies were reviewed. Results Among these 6 cases, 5 of them had Stanford B aortic dissection aneurysm, and the other one had descending thoracic aortic aneurysm. Speculative causes included air embolism （1 case）, plaque embolism （2 cases）, and low blood pressure during the procedure of endovascular repair （3 cases）. Three cases died, and the other 3 recovered but with accompanying nervous system symptoms. Conclusions The incidence of ischemic stroke occurring after endovascular thoracic aortic repair was relatively low, but the outcome was poor. Standardization of endovascular maneuver and medical instrument modification should be strengthened to avoid such complication.