颈内动脉次全闭塞的介入治疗及近端球囊装置与过滤装置在脑栓塞保护的比较

Stenting of subtotal conclusion of internal carotid artery and comparing the cerebral embolic load of proximal balloon protection device with distal filter protection device

目的通过回顾颈内动脉（ICA）次全闭塞的支架成形术及其围手术期情况，总结分析该手术的安全性和有效性，并比较近端球囊保护装置与远端过滤保护装置在栓子保护方面的优劣。方法回顾北京宣武医院2006--2012年所有颈内动脉次全闭塞患者的支架成形术，通过头颅MRI中DWI序列判断是否术后有无新发脑梗死，并计算每例患者新发脑梗死的病灶数量。结果共有35例颈内动脉次全闭塞的患者接受了支架手术，其中21例患者使用近端保护装置，14例使用远端过滤保护装置。32例患者术前及术后48d内行头颅MRI，近端球囊保护装置组的脑梗死发生率较远端过滤保护装置组低（6／18比10／14，P=0．03），脑梗死病灶数量也较远端过滤保护装置组少（1／18比4／14，P=0．0006）。所有患者术后3个月随访内未发生严重心脑血管事件，30例患者临床症状得到改善，3例患者颈动脉彩超显示支架术后发生再狭窄。结论症状性的颈内动脉次全闭塞的患者可考虑颈内动脉支架成形术，此手术采用近端球囊保护装置较远端过滤保护装置可能更有效的预防脑栓塞。颈内动脉次全闭塞的支架成形术仍有待大样本的临床随机对照研究进一步证实。

Objective To study the safety, efficacy and perioperative complications of endovascular therapy in the treatment of subtotal conclusion of internal carotid artery （ICA） in patients. To compare the cerebral embolic load of proximal balloon protection device versus distal filter protection device during the operation. Methods Review all the operations of stenting for subtotal conclusion of ICA in Xuanwu hospital. New cerebral infarction after stenting was assessed by diffusion-weighted magnetic resonance imaging. Count the number of new ischemic lesions of every patient. Results 35 patients with subtotal conclusion of ICA received endovascular stenting. Proximal protective device was used for 21 patients. Distal protective device was used for 14 patients. All procedures succeeded. 32 patients received the cerebral MRI 1 week before and within 48 hours after the operation. Compared with filter protection （ n = 14 ） , proximal balloon device （n = 18 ） resulted in a significant reduction in the incidence of new cerebral infarction（ 6/18 vs 10/14,P = 0. 03 ）. The number of new cerebral ischemie lesions were significant reduced by proximal balloon device（ 1/18 vs 4/14, P = 0. 0006）. There during the operation and the following up 3 months. were no serious cardiovascular events in 35 patients 3 patients had restenosis which was demonstrated by ultrasound of ICA at 3 months after stenting. Conclusions Endovascular stenting may be a safe and valid method for the treatment of subtotal occlusion of ICA. For the stenting of subtotal occlusion of ICA, proximal ballon protection device as compared with filter protection may reduce the embolic load to the brain more effectively. The stenting of subtotal occlusion of ICA still needs the randomized trails to confirm the safety and validity.