血管内支架治疗症状性颅内外动脉硬化性狭窄(附38例报告)

Angioplasty and stenting for symptomatic extracranial and intracranial atherosclerosis stenosis (report of 38 cases)

目的探讨血管内支架治疗症状性颅内外动脉硬化性狭窄的技术及其效果。方法 2006年7月至2010年9月收治的颅内外动脉硬化性狭窄伴血管迂曲患者38例,均采用血管内支架治疗。结果 36例支架成功置入,2例失败。治疗后血管狭窄程度由治疗前的90.23%±6.73%下降至5.46%±1.78%,治疗前后血管狭窄程度差异显著(P<0.05)。本组无死亡病倒。术后随访1月～4年,2例4年后复查DSA发现支架内再狭窄,再次给予支架置入治疗;2例支架内轻度狭窄,给予药物治疗。结论血管内支架成形术是治疗症状性颅内外动脉狭窄安全、有效的方法;当路径血管迂曲,支架到位困难时,影响介入手术的成功率,但是通过选择合适的支架、支撑力不同的导丝以及一定的技术调整,可提高手术成功率,减少并发症。

Objective To explore the technique of angioplasty and stenting for symptomatic extracranial and intracranial and atherosclerosis stenosis （S-EC-IC-AS） and its curative effect.Method Thirty-eight patients with S-EC-IC-AS,who had arterial tortuosity,were treated by angioplasty and stenting from July,2006 to September,2010.Results Of 38 patients with S-EC-IC-AS,36 successfully underwent angioplasty and stenting and 2 unsuccessful.The cavity of the treated arteries decreased by （90.23 ± 6.73）% before the treatment and decreased by （5.46±1.78）% of the original arterial cavity after the treatment in 36 patients.The diameters of the treated arteries were significantly longer after the treatment than those before the treatment in 36 patients （P 0.05）,in whom there was not transient ischemia attack during follow-up period of 1 month to 4 years.Two patients in whom there was restenosis within the stents 4 years after the treatment were treated again by stenting.Two patients in whom there was light restenosis within the stents 4 years after the treatment were treated by the drugs.Conclusions The angioplasty and stenting are the safe and effective method to treat S-EC-IC-AS.The difficulties of the stenting induced by the arterial atherosclerosis with tortuosity may be overcome by selecting the appropriate stents and wire with different support power and some technical adjustments,which can improve the successful rate of the stenting and reduce the complications related to the stenting in the patients with S-EC-IC-AS.