高危症状性颈动脉狭窄支架成形术的疗效分析

Carotid angioplasty and stenting for high-risk symptomatic carotid stenosis:an efficacy analysis

目的分析颈动脉支架成形术治疗高危症状性颈动脉狭窄的有效性和安全性。方法对20例高危症状性颈动脉狭窄患者进行颈动脉支架成形术治疗,其中男12例,女8例;年龄为62～76岁,平均69岁。其中短暂性脑缺血发作11例,脑梗死9例。对所有患者均行全脑血管造影,显示颈动脉狭窄率均>70%,其中一侧颈动脉重度狭窄9例(2例为颈动脉剥脱术后再狭窄);双侧颈动脉重度狭窄6例;一侧颈动脉闭塞,另一侧重度狭窄5例(1例为鼻咽癌放疗术后)。对所有患者使用脑保护装置,并均采用预扩张,预扩张后均使用自膨式支架。结果技术成功率为100%,残余狭窄率均<30%。所有患者术中均出现不同程度的短暂性心率、血压下降,1例患者出现了微栓子栓塞,无其他严重并发症;其余患者围手术期内无缺血性卒中发作。术后复查颈动脉超声见,显示狭窄明显改善。结论颈动脉支架治疗高危症状性颈动脉狭窄创伤小,围手术期并发症少,是安全、有效的。

Objective To analyze the effectiveness and safety of angioplasty and stenting （CAS） for treatment of high-risk symptomatic carotid arterial stenosis. Methods A total of 20 patients with high- risk symptomatic carotid arterial stenosis were treated with CAS. Among them, 12 were men and 8 were women, mean age 69 years （62 to 76 years ）. Of the 20 patients, 11 had TIA and 9 had cerebral infarc- tion. All patients underwent pan-cerebral angiography and it showed that the rate of carotid arterial stenosis 〉70% according to the North American Symptomatic Carotid Endarterectomy Trial （NASCET） criteria. Among them, 9 patients had unilateral severe carotid arterial stenosis （2 had restenosis after carotid endar- terectomy）, 6 had bilateral severe carotid arterial stenosis, 5 had unilateral carotid artery occlusion and contralateral severe stenosis （1 was after nasopharyngeal carcinoma radiotherapy）. The cerebral protection device and pre-dilation were used in all patients, and the self-expandable stents were used after the pre-di- lation. Results The success rate of the procedure was 100%. The rate of residual stenosis was 〈 30%. All patients had different levels of transient decrease of heart rate and blood pressure after the procedure. One patient had microembolic infarction, and no other serious complications were found. No other ischemic stroke occurred in the periprocedural period. The reexamination of carotid artery ultrasound after the proce- dures showed that the stenosis were improved obviously. Conclusion CAS is less invasive and its perioperative complications is rare. It is safe and effective for treatment of high-risk symptomatic carotid arterial stenosis.