脑梗死患者同侧颈动脉颅外段狭窄的血管内治疗

Percutaneous transluminal angioplasty and stenting for ipsilateral cerebral infarction patients with extracranial carotid stenosis

目的探讨脑梗死患者颅外段颈动脉狭窄血管内支架治疗的安全性、中短期疗效和适应证的掌握。方法对106例既往有脑梗死病史行血管内支架治疗的颅外段颈动脉狭窄患者的临床资料进行回顾性分析，分析其临床特点、治疗方法及预后。结果106例患者120个支架均置放满意。术后并发脑出血3例，支架内血栓形成2例，低血压、心动过缓6例，血管痉挛11例，消化道应激性出血1例，再狭窄8例，无脑梗死事件发生。除1例脑出血死亡、8例再狭窄外，其余97例患者中短期疗效满意。对83例患者随访3个月至5年，未出现相关脑缺血症状或新发脑梗死。结论血管内治疗颈动脉狭窄安全有效，适合既往存在脑梗死的患者；对此类脑梗死患者应更慎重地个体化评估手术风险，严格掌握手术适应证；围手术期的综合处理措施是防治并发症的关键。

Objective To evaluate the safety, middle or short - term effect and indication of the endovascular treatment for ischemic stroke patients with extracranial carotid stenosis. Methods The clinical datas with percutaneous transluminal angioplasty and stenting for extracranial carotid artery stenosis cases were retrospectively reviewed, from which 106 cases with ischemic stroke in the past were selected for study. And theinformation including operation opportunity, operation experience, serious complications such as cerebral hemorrhage and secondary ischemic stroke were summarized. Their clinical features, methods of treatment and prognosis were analyzed specially. Results The placement of 106 cases with 120 stents was satisfaction. Cerebral hemorrhage occurred in 3 cases while thrombosis fol- lowing stent placement in 2 cases, hypotension and bradycardia in 6 cases, vasospasm in 11 cases, gastrointestinal stress bleeding in 1 case, restenosis occurred in 8 cases and no cerebral infarction occurred after operation. Apart from one case of death cerebral hemorrhage,8 cases of restenosis ,the, middle or short -term results of the remaining 97 patients were satisfactory. 83 cases were followed up for 3 months to 5years ,there were no ischemic attack and cerebral infarction occurred. Conclusion The satisfactory effect and safety are achieved in the therapy of carotid stenosis by percutaneous transluminal angioplasty and stenting. Angioplasty and stenting may improve the cerebral hemodynamics of patients with severe/moderate internal carotid artery stenosis. It is suitable for previous ischemic stroke patients. We must be individualized to more carefully assess these patients surgical risk, strictly adhere to the indications of surgery, and general measures is the key of preventing the complications during the perioperative period.