颈内动脉狭窄血管成形及支架置入术临床探讨

Clinical discussion of carotid angioplasty and stenting in patients with carotid stenosis

目的分析颈动脉狭窄血管成形及支架置入术的围手术期治疗,总结操作经验,评价长期临床效果。方法总结32例颈动脉狭窄患者,均经影像学诊断确诊,行DSA再证实,局麻下行血管成形及支架置入术,3例患者由于不配合改用全麻,6例患者由于高度狭窄,术前PWI评价脑灌注,行分次治疗,在支架置入2周后局麻下行球囊扩张术。结果 32例患者支架覆盖斑块良好,术后残余狭窄<10%,1例患者同侧肢体偏瘫,经治疗6h后恢复。术后8例低血压,经多巴胺静脉维持后好转,7例一过性心动过缓,经对症治疗后好转。经1a随访,未出现脑卒中再发作,2例发生再狭窄行球囊扩张。结论术前综合评价、术中轻柔操作、防止低血压为手术成功和降低并发症的关键,分次治疗可降低高度狭窄病人术后高灌注综合征的发生几率。

Objective To analysis and discuss the perioperative treatment of carotid angioplasty and stenting in patients with carotid Stenosis, summarize processing experience, evaluate long-term clinical outcome. Methods 32 cases with carotid stenosis were summarized, all were diagnosed by image, and definite diagnosis were made by cerebral angiography,and carotid angioplasty and stenting were performed under local anesthesia, part of patients （3 cases）under general anesthesia because of non--cooperation, part of patients （6 cases） with high degree of stenosis were evaluated by PWI, and treated by 2 times, bal- loon dilatation were performed 2 weeks after deployment of stents. Results stents were deployed completed and covered plaques thoroughly, remainder stenosis ratio〈10%. 1 case had ipsilaterai limb hemiplegia, and recovered at 6 hours after treatment ; 8 cases had postoperative hypotension, recovered by intravenousing dopamine; 7 cases had transient bradycardia, and recovered by symptomatic treatment. After 1 year follow-up, stroke attack are not relapsed, 2 cases with restenosis were treated by balloon dilatation. Conclusion Preoperative evaluation, intraoperative soft operation and preventing low blood pressure are the keys of successful surgery and reducing the complications, and 2 times treatment may reduce the risk of high perfusion syndrome in patients with high degree stenosis after surgery.