脑动脉串联病变的同期腔内治疗

Endovascular treatment in cerebral artery tandem lesions

目的:评价对于症状性脑动脉串联病变进行同期腔内治疗的安全性和有效性。方法:回顾性分析2012年6月至2014年2月治疗的症状性脑动脉串联狭窄患者12例(24处病变),病变分布情况依次为:颈总动脉与颈内动脉开口部串联病变(1例)、颈内动脉开口部与颈内动脉海绵窦后膝近段串联病变(3例)、颈内动脉开口部与颈内动脉海绵窦后膝远段串联病变(4例)、颈内动脉颅内段与大脑中动脉M1段串联病变(2例)、椎动脉开口部与椎动脉颅内段串联病变(2例)。除颈内动脉开口部与颈内动脉海绵窦后膝远段串联病变为取得良好支撑力而先处理近端病变、后处理远端病变外,其余病例均采用了先处理远端病变、后处理近端病变的手术策略。病变部位的手术方案均为同期腔内支架成形术,麻醉方式视患者配合程度采用局部麻醉或者全身麻醉。观察12例患者围手术期并发症以及远期责任区域缺血性卒中的复发情况。结果:12例患者均顺利完成手术,技术成功率100%。围手术期无新发卒中事件,随访无支架内再狭窄及新发缺血性卒中事件。结论:经过选择的症状性脑动脉串联病变患者,进行同期腔内治疗处理串联病变是安全的,但需要术前详细的评估以及完善的手术预案。

Objective： To evaluate the effectiveness and safety of endovascular treatment in solving symptomatic cerebral artery tandem lesions. Methods： From June 2012 to February 2014, 12 cases （24 lesions） with symptomatic cerebral artery tandem lesions were accepted for the endovascular treatment. The distributions of the tandem lesions were as follows ： the common carotid artery and internal carotid ar- tery （ 1 case）, the internal carotid artery and the proximal of the carotid cavernous sinus segment （3 ca- ses）, the internal carotid artery and the distal of the carotid cavernous sinus segment （4 cases）, the in- tracranial segment of internal carotid artery and middle cerebral artery M1 segment （2 cases）, the first segment of vertebral artery and intracranial segment of vertebral artery （2 cases）. All of these cases were treated from distal lesions to proximal lesions except for tandem lesions in the internal carotid artery and the distal of the carotid cavernous sinus segment in order to obtain better support. Tandem lesions were treated in the same operation with local anesthesia or general anesthesia. The procedures of the 12 cases retrospectively were analyzed and the peri-operation complications and responsibility region recurrent is- chemic stroke incidents observed. Results：All tandem lesions were solved successfully all at once. There were no peri-operation complications or recurrent ischemic stroke incidents. There were no recurrent is- chemic stroke incidents or stent restenosis cases in the follow-up. Conclusion：It is safe and effective for selective endovascular treatment in solving symptomatic cerebral artery tandem lesions at the same time, but we should take careful preoperative evaluation and improve the operation plan.