超选择动脉内灌注及血管成形术治疗脑血管痉挛

Superselective intra-arterial infusion and percutaneous transluminal angioplasty for cerebral vasospasm

目的探讨早期超选择动脉内灌注及血管成形术 (PTA)治疗脑血管痉挛 (CVS)的效果。方法对 6例动脉近端狭窄段进行球囊扩张 ,对 3 8例大脑中动脉M2 段、大脑前动脉A1和A2 段痉挛者 ,灌注 0 .3 %罂粟碱 3 0 0～ 40 0ml,观察全脑血管造影和评价神经功能状态。结果复查全脑血管造影见痉挛血管全部有改善 ,术后 48小时临床状态和神经功能状态均得到改善 ,无死亡。术后 3月随访 ,恢复良好 2 7例 ,中度致残、生活能自理 11例。结论对于近端、局限性CVS宜采用PTA ,而对于远端。

Objective To evaluate the therapeutic effect of the superselective intra arterial infusion and percutaneous transluminal angioplasty(PTA)for cerebral vasospasm(CVS).Methods 38 cases of vasospasm at M 2 section of middle cerebral artery and A 1 and A 2 section of anterior cerebral artery were treated by local intravascular infusin of 0.3% papaverine 300 400 ml.6 cases of vasospasm near artery were dilated by balloon.Cerebral angioplasty and neurologic function were observed.Results Vasospasm vessel were all improved.At 48 hours after operation,clinical condition and neurologic function were improved and no death happened.Within 3 months follow up,27 cases recovered well and 11 cases with middle disabled degree could make a living by themselves.Conclusion PTA is best for near and local CVS,but superselective intra arterial infusion of papaverine is better for far and diffused CVS.