应用脑保护装置实施颈动脉支架成形术的临床经验

Carotid stent angioplasty under brain protection device

目的探讨脑保护装置在颈动脉支架成形术中的价值。方法自2000年10月至2006年8月对65例颈动脉狭窄患者实施了颈动脉支架成形术。共植入支架75个,其中颈内动脉支架68个,颈总动脉支架2个,同时植入锁骨下动脉支架2个,椎动脉支架3个,4例术前安装了临时起搏器。结果65例中2例脑保护装置置放失败,63例成功。63例脑保护装置中26例可见斑块碎片,1例术中出现一过性脑缺血,1例同时置入椎动脉支架后发生椎动脉血栓形成;9例术中出现一过性低血压、心动过缓,4例术前安装临时起搏器者未发生术中低血压。5例出现术后低血压,1例术后原有神经系统症状加重。1例双颈动脉支架成形术后出现高血压。结论颈动脉支架成形术是治疗颈动脉狭窄的有效手段,在有脑保护装置的条件下,正规熟练的操作和严格的预防措施能有效提高安全性,减少并发症。

Objective To investigate the value of brain protection device in carotid stent angioplasty. Methods From October 2000 to August 2006, 65 cases of carotid stenosis received carotid stent angioplasty under brain protection device and a total of 75 stents were implanted including 68 internal arotid artery stents, 2 common carotid artery stents, 2 concomitant subclavical artery stents and 3 vertebral artery stents. Four cases received temporary pacemaker preoperatively. Results There were two failures in the placement of brain protection device. Of the 63 successfully implanted brain protection device, atherosclerotic plaque debris were found in 26. Transient cerebral ischemia happened in one case during operation; One case, with simultaneous vertebral artery stent implantation, suffered from vertebral arterial thrombosis. Intraoperative transient hypotension and bradycardia occurred in 9 cases. There was no intraoperative hypotension in all the 4 cases who had received preoperative temporary pacemaker placement. Postoperative hypotension occurred in 5 cases. Preoperative nervous systematic symptom deteriorated in one case postoperatively. One with both carotid stents implantation suffered from postoperative hypertension. Conclusions Carotid stent angioplaty is an effective theraputic method in the treatment of carotid stenoses. Under brain protection device, skilful surgical expertise and strict preventive measures are conducive to the increase of safety and decrease of complications.