支架置入及经皮血管成形治疗颅外颈动脉狭窄

Effect of stent implantation and percutaneous transluminal angioplasty in the treatment of extracranial carotid artery stenosis

背景:颈动脉支架置入是一种微创、安全、简便的介入治疗方法,对于身体基础状况差不能耐受开放手术的颈动脉狭窄患者尤其有意义。目的:探讨支架置入联合经皮血管成形治疗颅外颈动脉狭窄的临床效果。方法:纳入颅外颈动脉狭窄患者29例,其中男19例,女10例,年龄45-78岁,进行支架置入及经皮血管成形治疗,治疗前及治疗后24 h进行美国国立卫生研究院卒中量表量表、神经功能评分及CT检查;随访3-12个月,复查凝血指标及颈动脉B超。结果与结论:1例患者为右侧颈总动脉分叉部完全闭塞,经治疗仅颈外动脉管径恢复50.0%,其余患者均经血管造影证实完全恢复至正常水平,治疗成功率为97%。29例患者治疗后24 h的颈动脉病变血管长度、美国国立卫生研究院卒中量表量表、神经功能评分均较治疗前明显改善(P<0.01,P<0.05)。随访3-12个月,所有患者均未出现脑梗死和短暂脑缺血发作,颈动脉狭窄明显改善,6个月复查时患者出现再狭窄,再狭窄率为3%。表明经皮血管成形联合生物材料支架置入治疗颅外颈动脉狭窄可以获得良好的临床效果。

BACKGROUND：Carotid artery stenting is a minimal y invasive, safe, simple intervention, which is particularly meaningful to patients with carotid artery stenosis who exhibit poor physical basis and cannot tolerate open surgery. OBJECTIVE：To explore the clinical effect of percutaneous transluminal angioplasty and stenting for treatment of extracranial carotid artery stenosis. METHODS：Twenty-nine patients with extracranial carotid artery stenosis, including 19 males and 10 females, age ranging from 45-78 years, were enrol ed and subjected to stenting and percutaneous angioplasty. American National Institutes of Health Stroke Scale, modified Rankin Scale and CT examination were tested before treatment and 24 hours after treatment. After 3-12 months fol ow-up, the coagulation indexes and B ultrasound of the carotid artery were reviewed. RESULTS AND CONCLUSION：One patient exhibited the complete bifurcation occlusion of the right common carotid artery, and only the diameter of external carotid artery recovered 50.0%. The remaining patients were confirmed by angiograph that completely restored to normal levels, and the success rate was 97%. At 24 hours after treatment, al the 29 patients exhibit significant improvement in the diameter of lesioned carotid artery, scores on American National Institutes of Health Stroke Scale and modified Rankin Scale （P〈0.01, P〈0.05）. During the 3-12 months fol ow-up, no cerebral infarction and transient cerebral ischemia occurred and carotid artery stenosis was improved in al patients. At 6 months after operation, one patient had restenosis, and the restenosis rate was 3%. Percutaneous angioplasty combined with biological material stenting for treatment of extracranial carotid artery stenosis can obtain good clinical effects.