血管内支架成形术治疗脑供血动脉狭窄的研究

Stent-assistant angioplasty for treatment of cerebral artery stenosis

目的 探讨血管内支架成形术治疗脑供血动脉狭窄患者的近期疗效,并发症及安全性.方法 行血管内支架成形术治疗的19例脑供血动脉狭窄患者,其中颈内动脉起始段狭窄13例[5例表现为短暂性脑缺血发作（TIA）,8例表现为脑梗死],椎动脉开口部狭窄6例,均表现为TIA.结果 19例患者支架全部成功置入,术前动脉狭窄程度平均为86%,术后残余狭窄程度平均为10%;明显增高的血流动力学恢复正常且持续保持;颈内动脉系统腩梗死患者NIHSS评分在术后明显改善.3例颈内动脉支架置入术患者出现一过性心率下降和血压下降,经药物治疗后均恢复正常.随访仅1例颈内动脉支架术后22周症状有所加重;1例椎动脉狭窄患者在术后19周出现1次TIA发作;其余患者术后随访6个月无症状复发.结论 血管内支架成形术是治疗脑供血动脉狭窄的一种安全、有效的治疗方法.

Objective To study the efficacy and safety of stent-assistant angioplasty （SAA） in the treatment of cerebral artery stenosis. Methods SAA was performed on 19 patients with cerebral artery stenosis, including 13 cases of stenosis at the initial segment of internal carotid （5 cases of transient ische mic attack and 8 cases of cerebral infarction） , and 6 cases of stenosis at the initial segment of vertebral artery （all exhibiting transient ischemic attack）. Results Nineteen stents were all successfully implanted. Mean artery stenosis （AS） before surgery was 86% , whereas the remnant stenosis after operation was 10%. The significantly increased hemodynamics reverted to normal after operation immediately and sustained during the follow-up. NIHSS in patients with cerebral infarction was improved Significantly after surgery. Postoperative bradycardia and hypotension occurred in three patients with internal carotid stenosis and treated by medicine. Only one case receiving carotid artery stent exhibited symptom deteriorated slightly during follow-up of the 22th week. One patient with vertebral artery stenosis exhibited one time of transient ischemic attack at the 19th week after surgery. The remaining patients had no recurrence of symptom during the follow-up of 6 months. Conclusion SAA for treatment of cerebral artery stenosis was safe and effective.