无名动脉狭窄或闭塞的腔内治疗

Endovascular treatment of innominate artery stenosis or occlusion

目的探讨腔内治疗无名动脉狭窄或闭塞的方法和疗效。方法回顾性分析2014年1月至2019年11月在首都医科大学宣武医院确诊为无名动脉狭窄或闭塞的11例患者资料,均接受腔内治疗。总结其症状、手术方式、并发症、支架通畅情况并分析患侧上肢收缩压及血液峰值血流速的变化。结果11例患者均行腔内支架成形术,手术均成功并获得随访,随访时间4~69(30.1±23.4)个月;2例术中使用脑保护伞,其中1例行同侧颈动脉内膜剥脱术,1例因对侧颈内动脉重度狭窄行支架植入术;1例术中发现无名动脉、左颈总动脉重度狭窄,一期行无名动脉支架植入术,半年后行左颈总动脉支架植入术。6例为股动脉入路,2例为肱动脉入路,1例经腋动脉与股动脉穿刺入路,2例为右颈部切开逆穿颈总动脉与股动脉联合入路。3例患者分别在术后第6、7、12个月出现支架内再狭窄,1例患者行无名动脉支架内球囊扩张术,2例患者行再次支架植入术,术后支架内血流均恢复通畅;1例术后14个月出现支架内再闭塞,因临床症状改变不明显未干预,本组病例临床再干预率为3/11,一期通畅率为7/11,二期通畅率为10/11。10例患者术后症状较前缓解,1例患者右上肢无力无明显改变。所有患者均无并发症。术前、术后右上肢收缩压、脉压差、无名动脉峰值血流速度相比较差异有统计学意义(P<0.05)。结论腔内治疗无名动脉狭窄或闭塞疗效确切,应根据病变情况及患者全身状况选择合适的手术入路和方案。

Objective To explore the method and effect of endovascular treatment to innominate artery stenosis or occlusion.Methods The data of 11 patients with stenosis or occlusion of innominate artery from January 2014 to November 2019 at Xuanwu Hospital of Capital Medical University were collected.All patients received endovascular treatment.We summarized the changes of clinical symptoms,surgical methods,perioperative complications,stent patency,and analyzed the changes in systolic blood pressure and peak blood flow velocity on the involving side.Results All 11 patients underwent endovascular treatment.The surgical technique success rate was 100%.All patients were followed up.The follow-up time was 4-69 months,with an average of(30.1±23.4)months.2 patients used cerebral umbrella during the operation.1 patient was performed ipsilateral carotid endarterectomy,1 patient underwent contralateral carotid stent implantation,1 patient was diagnosed as severe stenosis of the innominate artery and left common carotid artery,and an innominate artery stent implantation was performed at one stage,left common carotid artery stent implantation was performed after half a year.We done operation from the femoral artery puncture approach(6 patients),brachial artery puncture approach(2 patients),axillary artery and femoral artery puncture approach(1 patients),and right common carotid artery and the femoral artery puncture approach(2 patients).3 patients had in-stent restenosis at 6,7and 12 months after stenting,respectively.1 patient underwent balloon dilatation,and 2 patients underwent re-stent implantation.We have not do further intervention to 1 case of in-stent occlusion occurred 14 months after the stenting,for the clinical symptoms did not improve significantly.The clinical re-intervention rate in this group was 3/11,and the primary patency rate was 7/11.The secondary patency rate was 10/11.The symptoms of 10 patients were relieved and the weakness of right upper extremity was not significantly changed in 1 patient.No puncture point complications occurred in all patients,and no cerebral infarction occurred during the perioperative period.There were statistically significant differences in systolic blood pressure,blood pressure difference and peak blood flow velocity before and after the operation(P<0.05).Conclusions Endovascular treatment of innominate arterial stenosis or occlusion was safe and effective,and the appropriate surgical approach and plan should be selected according to the lesion characteristics and the whole body conditions.