颈动脉系统短暂性脑缺血发作的脑血管造影与介入治疗47例临床分析

Cerebral angiography and interventional treatment for transient carotid artery ischemic attacks:47 cases reports

目的 探讨短暂性脑缺血发作 (TIA)患者的脑血管病变基础及治疗方法。方法 对 4 7例颈动脉系统TIA患者行全脑血管造影 ,了解血管病变的程度。 7例颈动脉狭窄 >70 %的患者行自膨式支架置入治疗 ,37例行选择性动脉溶栓治疗。结果 本组患者脑血管造影显示大脑半球供血减少 3例 ,大脑中动脉狭窄 2 2例 ,大脑前动脉狭窄 1例 ,大脑后动脉狭窄 1例 ,颈内动脉狭窄 10例 ,颈总动脉狭窄 4例 ,未见血管异常影像 6例。应用自膨式支架治疗颈总、颈内动脉狭窄 >70 %的患者 7例 8处病变 ,共置入自膨式支架 12枚 ,残余狭窄均 <30 % ,随访 6～ 2 3个月 ,无再狭窄发生 ;选择性动脉溶栓治疗 37例 ,溶栓后脑血流明显改善 3例 ,好转 2 8例 ,无明显改善 6例。37例溶栓治疗者中 3例再次出现TIA发作 ,溶栓后对侧陈旧梗死灶出血 1例 ,无死亡病例。随访 3个月～ 3年 ,未见治疗血管发生脑梗死者。结论 TIA患者多已存在血管器质性病变 。

Objective To explore the basic reason and treatment for the patients with cerebral transient ischemic attacks (TIA).Methods 47 patients of TIA in carotid artery underwent cerebral angiography to comprehend the condition of cerebral vessels.7 patients with carotid artery stenosis greater than 70% underwent percutaneous transluminal self expanding stenting,37 patients underwent intraarterial thrombolytic therapy with UK.Results Cerebral angiography showed 3 cases with low blood flow at cerebral hemisphere;22 cases with stenosis in middle cerebral artery;1 case with stenosis at anterior cerebral artery,1 case at posterior cerebral artery,10 cases with stenosis at intracarotid artery,4 cases with stenosis at common carotid artery,6 cases with normal cerebral vessels.12 self expanding stents were used to treat 8 carotid artery stenosis in 7 patients,residual stenosis <30%.No re stenosis found in 6～23 months follow up.37 cases underwent intraarterial thrombolytic therapy with UK.28 cases got marked improvement,3 cases moderate improvement and 6 cases no change.3 cases with TIA again and 1case with re haemorrhage in lateral unfreshed infarcted area after thrombolytic therapy.No death and no infarction in 3～36 months follow up.Conclusions Most patients with TIA have cerebral sickness,needing immediate treatment