脑血管支架的临床应用及其并发症

Clinical application and complications of cerebrovascular stents

目的:介绍脑血管支架的国内外治疗研究进展,分析支架置入并发症的原因,并探讨各类脑血管支架与宿主间的生物相容性。方法:应用计算机检索Medline database(1989/2009)和中国期刊全文数据库(CNKI:1989/2009),由第一作者按纳入和排除标准,对文献进行筛选,资料收集和质量评价。从脑血管支架置入的治疗进展,支架置入治疗的并发症和脑血管支架的生物相容性3方面进行描述和整理。探讨各种脑血管支架的治疗现状、并发症和生物相容性。结果:总结归纳文献内容,脑血管支架临床应用较多的是颅内支架,由于血管的管径限制支架的直径,不同病变对支架直径的要求不同。支架置入并发症主要有腹膜后血肿,颈动脉窦反应,高灌注综合征,脑血管痉挛和血栓形成。在各种脑血管支架中,金属支架生物相容性较差,聚合物支架、涂层支架和药物支架生物相容性均好于金属支架,能有效的预防支架置入后的再狭窄。结论:脑血管支架置入治疗可作为脑血管病的主要治疗方式之一,在治疗过程中,要根据临床症状不同,进行充足的置入前准备,选择合适的支架类型,严格遵循适应证,避免出现并发症。脑血管支架中的药物支架,聚合物支架的生物相容性较好,其他支架生物相容性有待提高。

OBJECTIVE： To introduce advances of cerebrovascular stent at home and abroad, analyze causes for complications following stenting and explore the biocompatibility of cerebrovascular stent and host. METHODS： A computer-based online search of Medline database （1989/2009） and CNKI （1989/2009） was performed to select related articles. According to inclusion and exclusion criteria, the collected articles were selected and evaluated. The treatment advances, complications, and stent biocompatibility were described and summarized to explore the current status, complication and biocompatibility of various cerebrovascular stents. RESULTS： The content of articles was summarized. Intracranial stent is commonly used in clinic. The diameter of vessels confines diameter of stent, so different diseases have different requirements for diameter of stents. The complications following stenting include retroperitoneal hematoma, carotid sinus, hypertransfusion syndrome, cerebral angio spasm and thrombosis. In various stents, polymer, eluting and drug stents have better biocompatibility compared with metal stent, and can effectively prevent restenosis. CONCLUSION： Cerebrovascular stenting is one of the treatments for cerebrovascular diseases. During the treatment, sufficient operative preparation, appropriate stent and indication are important to avoid complications. Of various stents, polymer and drug stents have good biocompatibility, and the biocompatibility of other stents requires improvement.