症状性颅内外动脉狭窄血管内支架成形术并发症的临床分析

Clinical analysis of complications of endovascular stent angioplasty for symptomatic intracranial and extracranial arteries stenoses

目的探讨症状性颅内外动脉狭窄血管内支架成形术的并发症及其防治措施。方法回顾性分析接受血管内支架成形术治疗106例症状性颅内外动脉狭窄（狭窄率≥50%）患者的临床资料。结果本组103例成功进行血管内支架成形术,3例失败。21例（20.8%）出现脑血管并发症：无症状性动脉夹层1例;脑过度灌注损伤6例,其中死亡1例;缺血性卒中3例;靶病变部位急性血栓形成3例,经动脉内溶栓后即刻再通,均无后遗症;植入支架的血管发生再狭窄1例;脑血管痉挛4例。100例患者术后随访1~12个月,1例出现消化道大出血,1例出现再狭窄,2例高血压患者血压恢复正常,2例发生小卒中,1例肺部感染,1例死于肾功能衰竭。结论症状性颅内外动脉狭窄血管内支架成形术的并发症形式多样,规范抗血小板治疗及严格控制血压是防止围手术期靶病变部位急性血栓形成及出现高灌注综合征的关键;严格术前评估、规范操作可减少手术并发症。

ObjectiveTo observe the complications of endovascular stent angioplasty for symptomatic intracranial andextracranial arteries stenoses.MethodsThe clinical data of 106 patients with symptomatic intracranial and extracranial arteriesstenoses, who underwent endovascular stent angioplaysty, were analyzed retrospectively.ResultsThe complications includedasymptomatic artery dissection in 1 patient, cerebral over-perfusion in 6, of whom, 1 had asymptomatic cerebral hemorrhage, 4 hadsymptomatic hemorrhage and 1 died, ischemic stroke in 3, the acute thrombosis in target lesion site in 3, in whom, the occluded arterieswere recanalized after the thrombolysis, transient ischemia attacks in 2 and cerebral vasospasm in 4. The occurent rate of complicationswas 17.9%（19/106）. Of 100 patients followed up from 1 to 12 months after the angioplasty, 1 had digestive tract bleeding, 1 withdiabetes mellitus restenosis of the plastic artery, 2 little apoplexy in the cerebral area fed with blood to by non-plastic arteries, 2 diedand 94 had no any apoplexy events.ConclusionsThe complications of endovascular stent angioplasty for the symptomatic extracranialand intracranial arteries stenoses are varied. Standardized antiplatelet therapy and the strict control of blood pressure are the keys topreventing the perioperative acute thromboses in the target lesion site and overperfusion syndrome. Strict preoperative evaluation andstandard operation can reduce surgical complications significantly.