血管成形及支架植入术治疗颅外颈动脉狭窄的临床效果

Clinical Effect of Angioplasty and Stent Implantation in the Treatment of Extracranial Carotid Artery Stenosis

目的观察经皮腔内血管成形术(PTA)加颈动脉支架(CAS)植入术对颅外颈动脉狭窄(ECCAS)的疗效。方法选取2017年1月至2019年12月焦煤集团中央医院收治的68例ECCAS患者为研究对象。对无症状性颈内动脉狭窄>80%、症状性狭窄>50%的患者,根据路径迂曲程度、血管狭窄情况,选择合适的球囊预扩张满意后,将支架送至预想的位置释放,覆盖狭窄部位。比较患者治疗前后颈动脉血流参数,术后6个月复查数字减影血管造影(DSA),了解血管血流情况。随访1 a,观察患者预后。结果68例患者共70支血管接受PTA加CAS植入术治疗,共植入70枚支架,配合使用70枚保护伞,支架植入成功率为100%。DSA检查显示,血管狭窄程度由(88±10)%下降至(12±6)%,差异有统计学意义(P<0.05)。23例患者出现心率及血压下降,20例出现持续性心率下降及低血压,12例出现过度灌注表现,头颅CT未发现脑出血等严重并发症。术后第3天,患者颈动脉收缩期峰值流速(PSV)、颈动脉舒张末期血流速度(EDV)、血管阻力指数(RI)均较术前下降,搏动指数(PI)均较术前提高,差异有统计学意义(P<0.05)。术后6个月复查DSA,1例(1.47%)患者出现再狭窄,无明显临床症状,密切观察。随访1 a,脑梗死、短暂性脑缺血发作(TIA)发生率均为0。结论对于ECCAS患者,PTA加CAS植入术可有效改善血管狭窄程度,在适应证选择正确、围手术期处理得当的情况下,并发症少,安全性高。

Objective To observe the effect of percutaneous transluminal angioplasty(PTA)and carotid artery stenting(CAS)on extracranial carotid stenosis(ECCAS).Methods A total of 68 ECCAS patients admitted to the Coking Coal Group Central Hospital from January 2017 to December 2019 were selected as the research objects.For patients with asymptomatic internal carotid artery stenosis>80%and symptomatic stenosis>50%,the appropriate balloon was selected according to the degree of tortuous path and vascular stenosis.After the pre-dilation was satisfactory,the stent was delivered to the desired position and released to cover the stenosis.Compare the carotid artery blood flow parameters before and after the treatment.The digital subtraction angiography(DSA)was reviewed 6 months after the operation to understand the blood flow and vessels.Follow up for 1 year to observe the prognosis of the patient.Results A total of 70 blood vessels in 68 patients were treated with PTA and CAS implantation.A total of 70 stents were implanted and 70 protective umbrellas were used.The success rate of stent implantation was 100%.DSA showed that the degree of vascular stenosis decreased from(88±10)%to(12±6)%,which was statistically different(P<0.05).Heart rate and blood pressure decreased in 23 cases,persistent heart rate decrease and hypotension occurred in 20 cases,and hyperperfusion occurred in 12 cases.No serious complications such as cerebral hemorrhage were found on CT of the head.On the third day after the surgery,the carotid artery peak systolic velocity(PSV),carotid end-diastolic velocity(EDV),and vascular resistance index(RI)all decreased compared with preoperatively(P<0.05),and the pulsatility index(PI)increased compared with preoperatively(P<0.05).DSA was rechecked 6 months after the operation,and 1 case(1.47%)had restenosis without obvious clinical symptoms.During the 1 year follow-up,the incidence of cerebral infarction and transient ischemic attack(TIA)were both 0.Conclusion For ECCAS patients,PTA and CAS implantation could effectively reduce the degree of vascular stenosis.With the correct indications and proper perioperative management,the complications are few and safety is high.