脑血管支架种类及置入后的高灌注综合征

Cerebrovascular stent types and hyperperfusion syndrome following stenting

目的:重点介绍脑血管支架的种类,并分析支架置入并发症发生的原因。方法:以"脑血管,支架,高灌注综合征,并发症"为中文关键词;以:"cerebrovascular,support,hyperperfusion syndrome,Complication"为英文关键词,采用计算机检索2000-01/2009-12相关文章。纳入与与脑血管支架的种类相关文献及脑血管支架成形后高灌注综合征相关的文章;排除重复研究或Meta分析类文章。以20篇文献为主重点进行了讨论,并通过临床验证分析支架置入并发症的原因。结果:目前,支架置入被证明是治疗颅内外动脉狭窄所致缺血性脑血管病的有效手段。按照支架结构和材质可将血管内支架分为金属支架,聚合物支架,涂层支架等类型。金属支架虽然满足力学性能要求,但在置入人体后,存在血液相容性不佳等问题。支架表面粗糙度对再狭窄发生有很大的影响。高灌注综合征作为血管成形术后一种少见但严重的并发症值得关注,其发生在血管自动调节功能衰退并已适应低灌注压的血管床,通常在同侧出现颅内血管血流量显著增高,毛细血管床灌注压急剧增加而引起血脑屏障破坏,从而导致脑肿胀、颅内出血。结论:对覆膜材料进行表面改性处理,进一步提高其生物相容性,使并发症的形成减至最低限度,消除支架置入后人体排异反应和一系列并发症的发生,将是今后的研究方向。

OBJECTIVE： To discuss cerebravascular stent type and analyze complications following stenting. METHODS： A computer-based online search was performed for related articles published between January 2000 and December 2009 with the key words ＂cerebrovascular, support, hyperperfusion syndrome, complication＂. Articles regarding cerebravascular stent and hyperperfusion syndrome following stenting were included. Repetitive studies or Meta analysis were excluded. Finally, 20 articles were included, and the causes for complications following stenting were discussed. RESULTS： Currently, stenting has been demonstrated to effectively treat intracranial and extracranial artery stenosis-induced ischemic cerebrovascular disease. According to stent structure and quality, the endovascular stent is divided into metal, polymer, and eluting stents. Metal stent can meet the mechanical requirements, but it has poor compatibility. The rough surface of stent greatly affects restenosis. Hyperperfusion syndrome is a rare but severe complication following angioplasty. It occurs in vascular bed adaptable to hypoperfusion following vascular automatic regulation failure, characterized by increased intracranial blood flow. Capillary bed perfusion pressure is greatly increased, which leads to blood brain barrier damage and brain swelling and intracranial hemorrhage. CONCLUSION： Surface modification of coating materials, improvement of biocompatibility, minimization of complication and rejection following stenting are required in further study.