颈动脉支架治疗颈动脉狭窄的并发症

Complications in percutaneous transluminal stenting for carotid artery stenosis

目的探讨颈内动脉狭窄血管内支架治疗的并发症。方法对648例颈内动脉狭窄患者行全脑血管造影及颈部超声检查。365例患者使用脑保护装置,283例未使用保护装置283例。结果648例患者技术成功率为100%,患者症状消失或好转率为78.7%。心率<50次/min者占26.4%;术中栓子脱落5例,其中3例治疗后恢复,2例遗留一侧肢体运动障碍,术后颅内出血死亡3例,术后30d内总脑卒中或死亡6例,占1.2%。随访率为778%。再狭窄17例,占3.3%。结论颈内动脉狭窄的血管内支架治疗是安全的,但术前对临床及影像学检查正确评价,术中规范化操作及术后规范化护理,是减少并发症的关键。

Objective To discuss the complications of endovascular stenting for carotid artery stenosis. Methods Cerebral vascular angiography and cervical Doppler sonography were performed in 648 patients with carotid artery stenosis. Emboli-protected device was used in 365 patients and none in 283 patients. Results All 648 patients were technically successful （100%）. Symptoms disappeared or improved in 78.7% patients. Slow heart rate during operation existed in 26.4% patients. Embolism caused by dislodgment of emboli occurred in 5 patients, 3 of them recovered after treatment and 2 had unilateral dyskinesias. Intracranial hemorrhage occurred in 3 patients. Stroke or death within 30 days after operation occurred in 6 patients（1.24%）. 322 patients （77.8%）were followed up. Restenosis occurred in 17 patients（3.3%）. Conclusion Percutaneous transluminal stenting is a safe option for carotid artery stenosis. Correct evaluation of clinical and angiographic data before operation, together with normative manipulation and nursing during and after operation are the key points to avoid complications. （3 Intervent Radiol, 2007, 16： 291-294）