317例脑动脉支架患者围手术期危险性的临床分析

The clinical analysis of perioperative risk for cerebral artery stent in 317 patients

目的分析血管内支架手术并发症的相关原因,以减少发生类似并发症的几率,提高手术成功率。方法所有颅内动脉和椎-基底动脉均采用Apollo球囊扩张支架和Wingspan自膨式支架;颈动脉颅外段和锁骨下动脉均采用自膨式颈动脉支架。结果 317例脑动脉支架患者围手术期出现并发症26例(8.2%),术后30d仍有症状者16例(5.0%)。不同部位的发生率分别为:MCA 15.3%(11/72)、BA 11.9%(5/42)、ICA颅外段6.4%(6/94)、ICA颅内段14.3%(1/7)、VA起始段0%(0/17)、VA颅内段4.9%(2/41)和锁骨下动脉2.3%(1/44)。颅内支架并发症发生率11.73%明显高于颅外的4.52%(P<0.05)。按手术时间段计算,前6年12.5%高于后2年的6.3%,但无统计学意义(P>0.05)。结论脑动脉支架具有较高的危险性,其中MCA、BA和ICA支架的危险性更高,一定要严格掌握手术适应证。

Objective To analyze the related reasons for intravascular stent complications.Methods All intracranial arteries and vertebrobasilar arteries were transplanted with Apollo expandable stents and Wingspan self-expanding stents.Extracranial segment of the carotid artery and subclavian artery were transplanted with self-expanding artery stents.Results The 317 cases of cerebral artery stenting patients occured perioperative complications in 26 cases（8.2%）,among them,16 cases still had symptoms after 30 days（5.0%）.The incidence of different arteries were as following：middle cerebral artery,15.3%（11/72）;basilar artery,11.9%（5/42）;extracranial carotid artery,6.4%（6/94）;intracranial segment of carotid artery,14.3%（1/7）;initial segment of the vertebral artery 0%（0/17）;intracranial segment of the vertebral artery,4.9%（2/41）and subclavian artery,2.3%（1/44）.11.73% of intracranial stent complication rate was significantly higher than 4.52% of the extracranial one（P0.05）.Through operation time calculation,the rate of six years ago（12.5%）was higher than two years ago（16.3%）,but there was no statistical significance（P 0.05）.Conclusion There was really high risk for the cerebral artery stent,which was more higher in MCA,BA and ICA stens.So we must strictly master surgical indications.