症状性头颈部慢性动脉闭塞血管内治疗疗效分析

Analysis of therapeutic effects of intervenient therapy on symptomatic chronic occlusion of head and neck arteries

目的 探讨症状性头颈部慢性动脉闭塞血管内治疗的可行性及安全性。方法 回顾性分析2013年3月至2015年12月血管内治疗的24例头颈部慢性动脉闭塞的临床资料,其中椎动脉颅内段慢性闭塞3例、颈总动脉慢性闭塞3例、锁骨下动脉慢性闭塞5例、颈内动脉慢性闭塞13例。结果 24例中,22例目标血管成功开通,开通率为91.7%（22/24）,术后头晕、乏力等症状得到改善;2例颈内动脉慢性闭塞未开通,后期行颞浅动脉-大脑中动脉搭桥手术,术后头部CTA、DSA造影均显示灌注良好。1例左侧颈总动脉慢性闭塞血管内治疗中出现血栓脱落,造成同侧颈内动脉急性闭塞,术中通过急诊行Solitaire TM FR取栓治疗,术后患者病情平稳。术后随访5~14个月,NIHSS评分、m RS评分均为较术前有所改善,均无缺血性卒中事件再发生。结论 症状性头颈部慢性动脉闭塞血管内治疗具有可行性,近期疗效良好,长期疗效有待于进一步观察。

Objective To evaluate the effect of intervenient therapy on symptomatic chronic occlusion of head and neck arteries. Methods The clinical data of 24 patients with symptomatic chronic complete occlusion of arteries in the head and neck, of whom, 3 suffered from occlusion of intracranial section of vertebral arteries, 3 from the occlusion of common carotid arteries, 5 from the occlusion of subclavian arteries and 13 from the occlusion of internal carotid arteries, were analyzed. The intervenient therapy was performed in all the patients from March, 2013 to December, 2015. The curative effects were assessed 1, 7 and 30 days and a half year after the treatment. Results The occluded arteries were successfully recanalized by stenting in 22 patients （91.7%, 22/24）, in whom, the symptoms including limb weakness, dizziness and so on were improved. The condition was improved by taking out the thrombus with SolitaireTM FR in 1 patient with acute occlusion of the left internal carotid artery due to dropping out the thrombus during the intervenient therapy. This patient had good recovery. The good perfusion of cerebral tissues was showed by CTA and DSA after the superficial temporal artery-middle cerebral bypass surgery was performed in 2 patients in whom the occluded arteries were not recanalized by stenting. Conclusion The intervenient therapy is a new method to treat the chronic symptomatic complete occlusion of the arteries in the heads and necks and feasible but its long-term curative effect on the complete chronic occlusion of the head and neck arteries remains to be further observed.