颈动脉狭窄355例的血管内支架治疗

Percutaneous transluminal stenting for stenosis of internal carotid artery:a report of 355 cases

目的 总结颈内动脉狭窄血管内支架治疗的经验与并发症。方法 对 35 5例颈内动脉狭窄患者进行了血管内支架治疗。对全部患者在围手术期进行抗凝治疗 ,并行全脑血管造影及颈部超声检查。 72例患者使用脑保护装置 ;在未使用保护装置的 2 83例患者中有 2 0 2例患者采取预扩张 ,占 71 38% ;6 6例采取后扩张 ,占 2 3 32 % ;3例未扩张。结果 35 5例患者中 ,术中一过性心率下降占 2 5 0 7% ;术中微栓子脱落 5例 ,其中 3例治疗后好转 ,2例留有一侧肢体运动障碍 ;术后颅内出血死亡 2例 ,占 0 5 6 %。 2 5 6例患者症状消失或好转 ,占 84 77% ;对 2 6 0例患者进行了随诊 ,占73 34%。再狭窄 11例 ,占 4 2 3%。结论 采用正确的围手术期治疗及手术方法 ,颈内动脉狭窄的血管内支架治疗是安全的 ,对术后脑血管的过度灌注导致脑出血应予重视。

Objective To discuss the benefits and complications of percutaneous transluminal stenting for stenosis of internal carotid artery(ICA). Methods 355 patients with ICA stenosis were included from 1997 to 2003.All of them took periprocedual anticoagulation treatment,cerebral vascular angiography and cervical Doppler sonography. 72 patients used cerebral protection of filter devices. Among the 283 patients without cerebral protection 202 patients(71.38%) underwent predilation,66 patients(23.32%) underwent postdilation; and 3 patients underwent neither. Results The heart rates of 25.0% of all the patients decreased. Dislocation of microemboli happened in 5 patients. 2 of them improved after treatment . 3 of them got dyskinesia of one side . 2 patients (0.56%) died of intracerebral hemorrhage(ICH). 256 patients(84.77%) turned for the better. 260 patients(73.34%) were followed up. Restenosis occurred in 11 patients(4.23%). Conclusion Percutaneous transluminal stenting for stenosis of internal carotid artery is safe if proper periprocedual treatment and operative procedure are taken. However,enough attention should be paid to the occurrence of ICH resulting from over-flow after operation.