全脑血管DSA造影术在老年患者中的应用

The Application of Whole Cerebral Vascular DSA to Elderly Patients

目的探讨全脑血管DSA造影术在老年患者中应用的可行性、病变分布以及并发症等情况。方法对42例60岁以上脑血管病患者行全脑血管DSA造影术,并根据DSA造影的结果分析老年患者脑血管病的常见类型和部位,以及老年患者进行全脑血管DSA造影术的常见风险和避免措施。结果 42例患者中,全部经股动脉穿刺插管完成,结果显示:在28例出血性老年患者中,颅内动脉瘤破裂18例,动静脉畸形6例,烟雾病4例;在14例缺血性老年患者中,共发现颈部血管狭窄8处,前循环血管狭窄5处,后循环血管狭窄3处,未破裂动脉瘤1处。有5例患者出现轻度的脑血管痉挛,术后使用尼莫地平后症状缓解,1例出现股动脉穿刺点假性动脉瘤,1例出现股动脉穿刺点动静脉瘘,1例出现股动脉穿刺点血肿,均经过加压包扎、间断性按压后消失,1例出现导管扭曲打结,后经手法解旋后更换导管完成手术。在造影过程中,本组患者无1例出现继发性脑梗塞、动脉夹层形成等严重并发症。结论全脑血管DSA造影术作为一项诊断脑血管疾病重要的诊断方法,应用在老年患者中,是安全有效的,值得推广。

Objective To discuss the feasibility of application of whole cerebral vascular DSA to elderly patients, distribution of lesions and complications. Methods The 42 patients aged over 60 who with cerebrovascular disease were performing whole cwhole cere- bral vascular DSA. Then the type and location of disease were analyzed according to the results of DSA. Additionally, we also discussed the risks and preventive measures in elderly patients who need whole cerebral vascular DSA. Results All 42 patients completed cathe- terization through femoral artery. In 28 cases of elderly patients with bleeding cerebral vascular disease： 18 cases were diagnosed with ruptured intracranial aneurysms,6 cases with arteriovenous malformations and 4 cases with moyamoya disease. In 14 cases of elderly patients with ischemic cerebral vascular disease ：8 with cervical vascular stenosis,5 in anterior circulation and 3 in posterior circula- tion, l with unruptured intracranial aneurysms. The 5 cases had mild cerebral vasospasm, and symptom relieved after the use of nimo- dipine, 1 case had femoral artery puncture site pseudoaneurysm, 1 femoral artery puncture site arteriovenous fistula, 1 femoral artery puncture site hematoma, and all symptom relieved after compression bandaging,intermittent pressing. 1 had the catheter twisted into a loop, and finally surgery completed after replacement of the catheter. There were no serious complications such as secondary cerebral infarction and arterial dissection during angiography. Conclusion The whole cerebral vascular DSA is considered as an important diagnostic method for cerebral vascular diseases ,which is safe and worthy of promotion elderly patients.