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1.
目的探讨颈动脉内膜剥脱术(carotid endarterectomy,CEA)和颈动脉支架成形术(carotid artery stenting,CAS)治疗症状性重度颈动脉狭窄的近期和中期临床效果。方法回顾性地分析了2016年1月至2018年12月在我院接受CEA或CAS治疗的203例症状性重度颈动脉狭窄患者的临床资料,分析两种术式的围手术期及中期并发症情况。结果共纳入症状性重度颈动脉狭窄患者203人,分为CAS组(n=132)与CEA组(n=71),术后随访时间为1 y。统计学分析患者在年龄、性别、危险因素、血压等方面均无统计学差异(P>0.05)。围术期并发症分析中显示,CEA组颈部肿胀3例(P=0.017);CAS组30 d内卒中比例明显高于CEA组(P=0.034)。1 y随访结果分析显示,CAS组再狭窄比例明显高于CEA组(P=0.047);在心肌梗死、死亡、脑卒中方面两组间无明显统计学差异。结论CAS与CEA均可安全有效的治疗症状性重度颈动脉狭窄,围术期并发症方面CEA组颈部肿胀明显高于CAS组,CAS组30 d内卒中及1 y再狭窄比例明显高于CEA组。  相似文献   

2.
目的 观察应用血管内支架成形术治疗颅内外动脉狭窄引起的跌倒发作的疗效.方法 对2例颅内外动脉狭窄引起的跌倒发作患者(例1为基底动脉的中部、起始部,左椎动脉起始部及左锁骨下动脉重度狭窄;例2为双侧颈内动脉起始部重度狭窄)予以血管内支架成形术治疗,共释放6枚支架,例2应用保护伞.术后随访9个月~2年.结果 术后2例患者临床症状消失.例1随访9个月,术后6个月起因不规律服药,3个月后死于脑干梗死;例2术后1年复查DSA,无发生再狭窄,随访2年无临床症状复发.结论 血管内支架成形术是治疗颅内外动脉狭窄引起的跌倒发作安全、有效的方法.  相似文献   

3.
研究背景颈动脉扭曲被认为是血管内支架成形术的相对禁忌证,颈动脉内膜切除术为主要治疗方法。本研究探讨血管内支架成形术治疗颈动脉扭曲的可行性和安全性,并根据治疗结果初步总结临床经验。方法回顾分析22例接受血管内支架成形术治疗症状性颈动脉扭曲患者的临床资料,并对其临床表现、影像学特征、手术安全性及随访资料进行分析,评价治疗效果。结果 22例患者全部成功施行血管内支架成形术,支架植入成功率为100%,无一例发生支架相关死亡或残疾。共植入自膨式支架24个,术后颈内动脉平均狭窄率由术前的85.63%降至11.25%;扭曲角度(Metz观测分类法)由术前<90°全部纠正至>120°。住院期间无一例患者出现短暂性脑缺血发作或脑梗死,术前头晕、头痛等症状均有不同程度改善或完全消失;未发生永久性并发症或死亡。临床随访6~72个月,除1例发生支架对侧颈动脉系统短暂性脑缺血发作,2例出现同侧颈动脉系统短暂性脑缺血发作(1例血小板聚集试验呈阿司匹林抵抗、1例脑血管造影显示再狭窄),2例失访外,其余17例患者CT血管造影(10例)和B超(7例)检查均显示颈动脉血管形态良好、血流通畅,无再狭窄和扭曲发生。结论血管内支架成形术可治疗一定程度的颈动脉扭曲,其手术技术安全可行,有助于减少脑缺血发作,远期临床效果尚待进一步观察。  相似文献   

4.
目的对血管内介入治疗症状性基底动脉高度狭窄的有效性、安全性,以及近期疗效进行探讨。方法对经磁共振血管造影(magnetic resonance angiography,MRA)、CT血管成像(computed tomography angiography,CTA)或脑血管造影术(digital subtraction angiograyhy,DSA)证实为基底动脉高度狭窄(90%)并有相应临床症状的213例患者进行血管内介入治疗,对临床症状变化、手术成功率以及随访结果进行评估。结果 209例(209/213)基底动脉高度狭窄患者成功的进行血管内介入治疗,手术成功率为98.12%,平均狭窄率从术前的(93.70%±2.51%)降至术后的(11.60%±3.90%)。围手术期并发症8例(3.76%),缺血性卒中7例,蛛网膜下腔出血1例。平均随访(18.70±3.80)个月,202例患者再次行DSA,平均狭窄率为(13.80%±4.20%)。5例患者发生支架内再狭窄,其中1例表现为症状性狭窄。结论基底动脉高度狭窄的血管内介入治疗具有有效、安全的优点,术后1.5年随访结果显示血管通畅率好以及能够较好的预防后循环缺血事件的发生。  相似文献   

5.
Both carotid endarterectomy (CEA) and carotid artery stenting (CAS) are common treatments for carotid artery stenosis. Several randomized controlled trials (RCTs) have compared CEA to CAS in the treatment of carotid artery stenosis. These studies have suggested that CAS is more strongly associated with periprocedural stroke; however, CEA is more strongly associated with myocardial infarction. Published long‐term outcomes report that CAS and CEA are similar. A reduction in complications associated with CAS has also been demonstrated over time. The symptomatic status of the patient and history of previous CEA or cervical radiotherapy are significant factors when deciding between CEA or CAS. Numerous carotid artery stents are available, varying in material, shape and design but with minimal evidence comparing stent types. The role of cerebral protection devices is unclear. Dual antiplatelet therapy is typically prescribed to prevent in‐stent thrombosis, and however, evidence comparing periprocedural and postprocedural antiplatelet therapy is scarce, resulting in inconsistent guidelines. Several RCTs are underway that will aim to clarify some of these uncertainties. In this review, we summarize the development of varying techniques of CAS and studies comparing CAS to CEA as treatment options for carotid artery stenosis.  相似文献   

6.
Andgren S, Sjöberg L, Norrving B, Lindgren A. Time delay between symptom and surgery in patients with carotid artery stenosis.
Acta Neurol Scand: 2011: 124: 329–333.
© 2011 John Wiley & Sons A/S. Objectives – Many severe strokes are preceded by warning signs such as a transient ischemic attack or stroke with minor deficits. Carotid endarterectomy (CEA) of a symptomatic carotid artery stenosis can prevent future strokes, but should be performed within 2 weeks after the initial symptom to maximize the benefit. The aim of this study was to determine the time delays between symptom and CEA. Methods – We performed a single center observational retrospective study at a tertiary stroke center. A total of 142 carotids in 139 patients with symptomatic stenoses between 2002 and 2006 were included. The main outcome measure was time between qualifying cerebrovascular symptom and CEA. Results – The median time between symptom and CEA was 26 days. The longest delays were between the last diagnostic examination and carotid conference, and between carotid conference and surgery. The median time was shorter for those who received emergency medical care (median 21 days) and for those who were admitted immediately to hospital (median 20 days). Conclusions – The time between symptom and surgery is often longer than desirable. There are several measures to improve the chain of procedures for patients with carotid artery stenosis. These may include omitting the formal carotid conference for uncomplicated cases and minimizing waiting time for surgery.  相似文献   

7.
ABSTRACT

Objective: Previous studies have demonstrated a strong association between carotid artery stenosis (CAS) and coronary artery stenosis disease (COAS). However, prior evaluated methods are non-invasive examinations. This study was aimed to access the relationship between CAS and COAS by the means of angiography.

Methods: This is a single-center, retrospectively reviewed study based on digital subtraction angiography (DSA) of carotid artery and coronary artery angiography (CAG). We collected a total of 231 patients undergoing DSA and CAG at the same-day between June 2013 and May 2015. The patients were stratified according to the degree of CAS and COAS, mild stenosis <50%, moderate stenosis 50–69%, severe stenosis 70–99%, occlusion 100%. The correlation of CAS with COAS, as well as the risk factors, was analyzed.

Results: A total of 231 patients was enrolled in this study, male 71.9% (166/231). The age ranges from 32 to 80, mean age 60.06 ± 9.98. Of these patients, 79 patients were severe CAS and 128 patients were severe COAS. Statistical analysis demonstrated that the independent risk factors of severe COAS ≥70%, were age, sex, previous cerebral infraction, coronary heart diseases, and coronary artery surgery. CAS was associated with COAS (Spearman r = 0.333, P < 0.01). The more serious the CAS, the more involved COAS (Kendall’s tab-b = 0.294, p < 0.01).

Conclusions: The DSA confirmed CAS was associated with CAG confirmed COAS. The heavier the CAS is, the more the number of the affected coronary artery.  相似文献   

8.
目的探讨颈动脉内膜切除术治疗颈动脉狭窄的手术技巧,提高手术疗效,降低术中不良事件及术后并发症发生率。方法共53例颈动脉狭窄患者,右侧狭窄26例、左侧15例、双侧12例;中度狭窄(30%~69%)35例、重度狭窄(70%~99%)16例、完全闭塞2例。结果其中50例单纯行颈动脉内膜切除术、2例行颈动脉内膜切除术联合动脉瘤夹闭术、1例颈动脉支架成形术后管腔狭窄者行颈动脉内膜切除术并支架取出术。术后颈部CTA及灌注成像提示颈动脉血管形态良好、血流通畅,脑组织灌注不同程度改善。随访3~24个月,1例因心肌梗死死亡、2例术侧颈部皮肤麻木、1例声音嘶哑、3例仍有轻度短暂性脑缺血发作,无脑卒中病例。结论颈动脉内膜切除术是治疗颈动脉狭窄性病变安全、有效的外科方法,正确选择手术适应证及娴熟的手术技巧是保证手术成功、提高疗效的关键。  相似文献   

9.
11例颈动脉盗血综合征临床分析   总被引:3,自引:3,他引:0  
目的分析11例颈动脉盗血综合征(CSS)的临床表现和影像学特点,评估其侧支循环建立与代偿方式及不同治疗方式的预后,为CSS的诊治提供依据。方法纳入2016年1月~2016年5月住院治疗的CSS患者11例。所有患者均进行颈部血管彩超、头颅CT血管造影(CTA)或磁共振血管成像(MRA)、数字剪影血管造影(DSA)等检查明确CSS诊断,进行侧支循环代偿评估。11例CSS患者中,4例患者行颈动脉内膜剥除术(CEA),5例行颈动脉内支架植入术(CAS),2例颈动脉闭塞患者药物保守治疗。对11例患者在治疗3个月、6个月和1年后进行随访,并评估缺血性脑血管事件及改良RANKIN量表评分(mRs)。结果 11例CSS患者中,单侧颈内动脉病变7例,双侧颈内动脉病变4例。临床表现为短暂性脑缺血发作7例,分水岭梗死3例,腔隙性脑梗死1例;其中后循环缺血7例,前循环缺血4例。DSA评估侧支循环建立单以一级侧支循环(11例)和二级侧支循环(4例)开放为主。ASITN评分大部分为3~4级。治疗后随访,有2例行CAS的患者出院后出现不同时期卒中样症状,4例行CEA的患者随访期内均未发生卒中。CAS和CEA术后3个月、6个月和1年的mRs评分均有不同程度改善。结论 CSS患者多发生于颈动脉狭窄严重患者,其侧支循环开放良好,以一、二级侧支循环开放为主,临床表现以后循环缺血症状多见。CAS及CEA能改善颈动脉狭窄,可能成为CSS的治疗手段。  相似文献   

10.
Background Little is known about the natural course of internal carotid artery (ICA) occlusion and its possible recanalization. The present study was designed to evaluate recanalization rates of extracranial ICA occlusions in acute stroke patients by means of color-coded duplex sonography (CCDS). Methods 305 patients with acute ischemia in the territory of the middle cerebral artery were included in this study. All patients had a neurological examination on admission and on discharge and were rated by means of the European Stroke Scale (ESS). Extracranial color-coded duplexsonography, transcranial Doppler sonography and cranial computed tomography were immediately performed after admission and within 7 days. Results 254 patients showed no sign of hemodynamic relevant stenosis greater than 70 % of the ICA. 21 patients had symptomatic high grade ICA stenosis. 20 patients had an acute occlusion and 10 patients an old ICA occlusion as judged by duplex sonographic criteria. Six patients (5 male, 1 female; age range 57 to 77 years) with an acute atherothrombotic or cardioembolic occlusion showed a recanalization of the ICA in the follow-up ultrasonography. Two patients with cardiogenic embolic occlusion of the ICA had the most favorable outcome and these patients showed no residual stenosis. 4 patients who had ultrasound findings consistent with atherosclerosis on follow-up examination (2 high-grade stenosis, 2 with carotid plaques) did not show a notable improvement of their ESS-score. Patients with carotid plaques developed complete MCA infarctions; the other 4 patients had partial anterior circulation infarction on follow-up CT. Conclusions The present study showed that recanalization of the occluded ICA in acute stroke patients is more frequent than generally presumed. CCDS should be routinely performed in the follow-up of stroke patients as spontaneous recanalization may influence clinical outcome. Received: 11 April 2001, Received in revised form: 13 June 2001, Accepted: 18 June 2001  相似文献   

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