支架治疗症状性MCA狭窄围手术期并发症原因及防治措施

The causes and prevention in perioperative complications of symptomatic MCA stenosis treated with stenting-angioplasty

目的探讨血管内支架置入术治疗症状性大脑中动脉狭窄围手术期并发症的原因及防治措施。方法对入选48例大脑中动脉狭窄患者行支架置入术,手术前后行NIHSS评分及血管狭窄率(WASID标准)计算,并观察围手术期并发症及其发生率。结果 48例患者共置入50枚支架,其中2例因颅内血管过度迂曲,支架未能达到狭窄部位,1例因血管严重痉挛而放弃手术治疗,手术成功率93.75%,手术前后DSA狭窄率、NIHSS评分分别为[(75.61±7.15)%、(19.14±5.69)%,P<0.05](5.21±1.68%,2.20±0.99%,P<0.05),差异均有统计学意义。围手术期并发症7例,其中血管痉挛2例,颅内出血2例,新发缺血事件3例。结论支架治疗大脑中动脉狭窄手术成功率高,疗效确切,但围手术期并发症的防治有待加强。

Objective To investigate the causes and perventicn in perioperative complications of symptomatic MCA stenosis treated with stenting-angioplasty.Methods 48 patients with MCA stenosis were treated with stenting.NIHSS score was performed to assess clinical symptoms and signs,and WASAID standard for vascular stenosis was calculated,Meanwhile perioperative complications and their incidence were counted before and after stenting.Results 50 stents were placed in 48 patients,operation achievement ratio was 93.75%.2 cases failed to achieve the destination due to excessive intracranial vascular tortuosity,and 1 case had to give up because of the severe cerebral vasospasm.Vasular stenosis rate and NHISS score were respectively displayed as following（75.61%±7.15%,19.14%± 5.69%,P0.05）,（5.21%±1.68%,2.20%±0.99%,P0.05）and there were significant difference before and after stenting.7 cases of perioperative complications were occurred including 2 cases with Vasospasm,2 cases with intracrania hemorrhage and 3 cases with new ischemia.Conclusion It is a feasible and effective technique to treat symptomatic MCA stenosis with stenting-angioplasty.However,the prevention and treatment of perioperative complications need to be strengthened.