近端血流阻塞式脑保护装置下颈动脉支架成形术的临床研究

Clinical research of carotid artery stenting under the protection of proximal embolic protection device

目的研究近端血流阻塞式脑保护装置MO．MA系统在颈动脉支架成形术中预防脑血管栓塞的疗效，并评价其安全性及可操作性。方法2007年10月至2008年7月，23例符合外科治疗指征的颈动脉硬化狭窄患者入选本研究，其中19例（82．6％）患者有神经系统症状。全脑血管造影后在脑保护装置MO．NA系统下行颈动脉球囊扩张及支架成形术，计算术中脑缺血时间，观察术中及术后30d神经系统事件的发生情况。结果颈动脉造影示，6例（26．1％）颈动脉狭窄50％～70％，17例（73．9％）颈动脉狭窄〉70％。所有病例在MO．MA系统保护下颈动脉球囊扩张及支架植入均顺利进行，颈动脉平均阻断时间（5．3±1．2）min。术中及围手术期无死亡及脑卒中发生；2例在颈总动脉球囊阻断时出现短暂意识丧失伴对侧肢体短暂抽搐；2例术后出现心动过缓和低血压，持续时间分别为6h及1周。9例患者术中颈动脉抽血中可见细小斑块碎片。术后30d随访有1例TIA发作，1例对侧新发脑卒中，术后30d累积脑卒中发生率及病死率为4．3％。结论应用近端血流阻断式脑保护装置MO．MA系统在颈动脉支架成形术中预防神经系统事件发生是安全有效的，尤其适合重度及不稳定性斑块的颈动脉硬化狭窄支架成形术治疗。

Objectives To study the efficacy of proximal embolic protection device in preventing intracranial artery embolization during Carotid artery stenting （CAS） and to evaluate its security and maneuverability. Methods From October 2007 to July 2008, 23 patients with carotid artery stenosis who were suitable for surgical therapy according to the standards of NASCET or ACAS were enrolled in this clinical research. Among them 19 patients （ 82.6% ） were symptomatic, 6 patients （ 26. 1% ） with 50% - 70% stenosis and 17 cases （73.9%） with 〉70% stenosis. M1 the patients received carotid angioplasty and stenting under the protection of MO. MA system （one kind of proximal embolic protection device ）. We recorded the cerebral ischemic time during the procedure and observed neurologic events within 30 days. Results All the procedures were performed successfully, the mean cartiod artery blocking time was （5.3 ± 1.2） min. No death or stroke occurred during perioperative period. Two cases of patients developed transient loss of consciousness combined with contralateral limb convulsion, while the common carotid artery was occluded by balloon. Two cases of patients developed bradycadia, sustained 6 hours and 1 week. Plaque debris in the withdrawal blood from carotid artery were found in 9 cases. At 30-day follow-up after CAS, TIA occurred in 1 case, new contralateral stroke occurred in 1 case, the incidence of 30-day stroke and death rate was 4. 3%. Conclusion The application of proximal embolic protection device in CAS procedure for preventing neurologic complications is safe and effective, espicially for severe stenosis and unstable plaque in carotid artery stenting.