经皮血管内支架术治疗粥样硬化性颈动脉狭窄(英文)

Percutaneous transluminal stenting in patients with carotid artery stenosis

目的 观察经皮血管内支架术治疗粥样硬化性颈动脉狭窄的疗效和安全性。方法 经血管造影证实颈动脉≥ 70 %狭窄的TIA和恢复良好中风患者择期行经皮血管内支架术。观察手术成功率及手术相关并发症。 6个月随访患者TIA或中风发生率并血管造影或磁共振造影观察再狭窄发生率。结果 2 6例患者 2 7处颈动脉狭窄中分叉处病变 17例 ,合并冠心病 18例。手术即刻成功率 96 3% (2 6 / 2 7)。 2 6例成功者颈动脉狭窄由 88 6 %± 8 9% (70 - 10 0 )减至 0 4 %± 2 0 % (0 - 10 )。术中球囊扩张时 6例出现严重低血压和心动过缓 ,3例一过性意识丧失及肢体麻痹。术后 7小时和 14天 2例患者分别出现肢体抽搐和意识丧失 ,12小时后缓解 ,考虑为过度灌注综合症。住院期间小中风 2例 ,无大中风和死亡。 6个月随访无新发生中风和TIA发作。 16例术后 6 - 16个月血管造影无再狭窄发生 ,其余 10例术后 6 - 16个月磁共振血管造影亦无再狭窄发生。结论 经皮血管内支架术治疗粥样硬化性颈动脉狭窄即刻成功率高、并发症较少且轻微 。

Objective To assess the efficacy and safety of percutaneous transluminal stenting for patients with carotid artery stenosis.Methods Selective percutaneous transluminal stenting was performed for patients with symptomatic carotid artery stenosis(luminal narrowing ≥ 70%).Success rates and complications associated with the procedures were observed.During six months of follow-up,both recurrent symptom and restenosis rates were recorded.Results There were 17 bifurcating lesions among 27 stenoses in 26 patients,of whom 18 had concomitant coronary artery diseases.The acute procedural success rate was 96.3%(26/27),and the degree of stenosis was reduced from 88.6% ± 8.9%(range 70 - 100)to 0.4% ± 2.0%(range 0 - 10).Six patients developed severe bradycardia and hypotension,and 3 experienced transient loss of consciousness during balloon dilatation.During hospitalization,2 patients experienced loss of consciousness and convulsion,respectively,due to hyperperfusion,and both recovered 12 hours later.There were 2 minor stroke cases (7.4%)but no cases of major stroke or death.At the 6-month follow-up,there were no cases of TIA or new onset of stroke.There was no restenosis detected in 16 cases using angiography and in 10 cases using MRI in 6 to 16 months of follow-up.Conclusions Percutaneous transluminal stenting for patients with carotid artery stenosis has a high procedural success rate with few and acceptable complications.Few patients suffered from recurrent symptoms or showed restenosis in long-term follow-up.