血管内支架置入治疗高危颈动脉狭窄

Endovascular stenting for high risk patients with high grade internal carotid stenosis combined with occlusion of the contralateral carotid artery

目的 评价伴对侧颈内动脉闭塞的高危颈内动脉狭窄病人血管内支架治疗的疗效和安全性。方法 8例不适合颈动脉内膜剥脱的高危颈内动脉狭窄病人接受了血管内支架置入治疗。术前颈内动脉平均狭窄程度为 (85 2± 9 4) % (70 %～ 98% )。术前和术后 2 4h采用NIHSS评分 ,术前和术后 3个月采用改良Rakin评分标准对这些病人进行神经功能评分。术后随访 6～ 1 4个月。结果 术中造影证实 8枚支架均放置成功 ,残余狭窄程度 (5 3± 2 2 ) % (5 %～ 9% ) ,管腔狭窄程度较术前明显改善 (t=4 79,P <0 0 0 1 )。术中没有发生与手术相关的并发症 ,术后 2 4h病人的NIHSS神经功能评分保持在术前水平 [(2 5± 2 4)分 ] ;术后 3个月 ,改良Rakin神经功能评分为 (1 1 3± 0 99)分 ,同术前 (1 2 5± 1 2 8)分比较差异无显著性意义 (T =1 89,P >0 0 5)。术后随访 6～ 1 4个月 ,除 1例偶发一过性脑缺血发作 (TIA)外 ,其他病人未再出现TIA和新的中风。结论 血管内支架置入术是治疗高危颈内动脉狭窄安全。

Objective To evaluate the efficacy and safety of endovascular therapy for high risk patients with high grade internal carotid artery stenosis combined with occlusion of the contralateral internal carotid artery. Methods From October,2000 to December,2001, 8 patients with high grade stenosis of one internal carotid artery combined with occlusion of the other whose conditions were not suitable for carotid endarterectomy, were treated through endovascular approach. The stenotic degree of the lesions before procedures was (85.2±9.4)%(70%-98%). NIHSS was used to evaluate the neurological function before and after endovascular stenting, and modified Rakin scale was used before and 3 months after endovascular stenting. Carotid arterial ultrasound and transcranial Doppler (TCD) examinations were used before and 2 days, 3 months, 6 months, 12 months after procedure. The averaged follow up duration was 9 months (6-14 months). Results Predilation was made in 3 patients in whom the stenotic degree of the lesions was more than 90%. Five Smart self expanding stents and 3 Wallstent were applied in the 8 patients. All the procedures were technologically successful, and the residual stenosis after procedures were (5.3± 2.2)% (5%-9%). The carotid stenosis after procedure was improved significantly compared with that of preoperation( t =4.79, P <0.001). There were no clinical complications associated with the procedures. The NIHSS score of all the patients remained unchanged 24 hours after the procedures. The average modified Rakin score 3 months after stenting was (1.13±0.99), showing no significant difference compared with that of preprocedure(1.25±1.28)( T =1.89, P >0.05). Results of carotid ultrasound and TCD examinations showed that the stenotic arteries in which stents were placed were patent, the velocity of blood flow after procedures was markedly improved, and the blood perfusion improved not only at the procedure side but also at the carotid occlusive side in some patients. Neither new stroke nor TIA happened during the follow up period. Conclusion Endovascular stenting is an effective and safe method for the treatment of high risk internal carotid stenosis combined with occlusion of the contralateral internal carotid artery which is not suitable for carotid endarterectomy.