支架治疗症状性MCA狭窄围手术期并发症原因及防治措施

目的探讨血管内支架置入术治疗症状性大脑中动脉狭窄围手术期并发症的原因及防治措施。方法对入选48例大脑中动脉狭窄患者行支架置入术,手术前后行NIHSS评分及血管狭窄率(WASID标准)计算,并观察围手术期并发症及其发生率。结果 48例患者共置入50枚支架,其中2例因颅内血管过度迂曲,支架未能达到狭窄部位,1例因血管严重痉挛而放弃手术治疗,手术成功率93.75%,手术前后DSA狭窄率、NIHSS评分分别为[(75.61±7.15)%、(19.14±5.69)%,P<0.05](5.21±1.68%,2.20±0.99%,P<0.05),差异均有统计学意义。围手术期并发症7例,其中血管痉挛2例,颅内出血2例,新发缺血事件3例。结论支架治疗大脑中动脉狭窄手术成功率高,疗效确切,但围手术期并发症的防治有待加强。     

症状性非急性大脑中动脉闭塞血管再通治疗研究

目的总结症状性非急性大脑中动脉闭塞血管再通治疗的可行性、有效性和安全性。方法纳入2019年1-12月行血管再通治疗的8例非急性大脑中动脉闭塞患者,记录血管再通成功率、围手术期并发症、预后和支架内再狭窄情况。结果 8例患者中7例血管再通成功,1例失败。其中4例发生围手术期并发症,包括症状性颅内出血(2例)、短暂性脑缺血发作(1例)和支架内血栓形成(1例)。术后7和30 d改良Rankin量表评分0～2分6例、3分1例、4分1例。术后4个月1例发生支架内再狭窄。结论症状性非急性大脑中动脉闭塞患者,药物治疗效果欠佳时可考虑血管再通治疗,但该项技术复杂,围手术期并发症发生率较高。     

症状性颅内外动脉狭窄血管内支架成形术并发症的临床分析

目的探讨症状性颅内外动脉狭窄血管内支架成形术的并发症及其防治措施。方法回顾性分析接受血管内支架成形术治疗106例症状性颅内外动脉狭窄（狭窄率≥50%）患者的临床资料。结果本组103例成功进行血管内支架成形术,3例失败。21例（20.8%）出现脑血管并发症：无症状性动脉夹层1例;脑过度灌注损伤6例,其中死亡1例;缺血性卒中3例;靶病变部位急性血栓形成3例,经动脉内溶栓后即刻再通,均无后遗症;植入支架的血管发生再狭窄1例;脑血管痉挛4例。100例患者术后随访1~12个月,1例出现消化道大出血,1例出现再狭窄,2例高血压患者血压恢复正常,2例发生小卒中,1例肺部感染,1例死于肾功能衰竭。结论症状性颅内外动脉狭窄血管内支架成形术的并发症形式多样,规范抗血小板治疗及严格控制血压是防止围手术期靶病变部位急性血栓形成及出现高灌注综合征的关键;严格术前评估、规范操作可减少手术并发症。     

症状性大脑中动脉重度狭窄球囊扩张支架治疗效果及安全性分析

目的 探讨症状性大脑中动脉M1段重度狭窄血管内球囊扩张支架治疗的安全策略.方法 收集兰州军区兰州总医院神经内科自2007年7月至2010年8月经全脑血管造影诊断的经球囊扩张支架治疗的症状性大脑中动脉M1段重度狭窄32例患者的临床资料,回顾性分析总结技术成功率、围手术期管理及并发症、随访期卒中发生以及血管再狭窄等情况.结果 本组技术成功率为93.8%(30/32):围手术期共出现2例脑梗死并发症,其中1例为无症状性,未出现其它并发症;平均随访时间12.6月,随访期间未出现新发卒中病例以及死亡病例事件.结论 积极药物治疗基础上的球囊扩张支架治疗大脑中动脉重度狭窄性病变是安全有效的,但围手术期存在一定的脑梗死事件风险.     

症状性大脑中动脉重度狭窄球囊扩张支架治疗效果及安全性分析

目的 探讨症状性大脑中动脉M1段重度狭窄血管内球囊扩张支架治疗的安全策略.方法 收集兰州军区兰州总医院神经内科自2007年7月至2010年8月经全脑血管造影诊断的经球囊扩张支架治疗的症状性大脑中动脉M1段重度狭窄32例患者的临床资料,回顾性分析总结技术成功率、围手术期管理及并发症、随访期卒中发生以及血管再狭窄等情况.结果 本组技术成功率为93.8%(30/32):围手术期共出现2例脑梗死并发症,其中1例为无症状性,未出现其它并发症;平均随访时间12.6月,随访期间未出现新发卒中病例以及死亡病例事件.结论 积极药物治疗基础上的球囊扩张支架治疗大脑中动脉重度狭窄性病变是安全有效的,但围手术期存在一定的脑梗死事件风险.     

颈动脉支架置入术围手术期护理体会

目的探讨支架治疗重度颈动脉狭窄病人的围手术期护理。方法13例重度颈动脉狭窄的病人在支架治疗围手术期内行常规护理，包括心理护理、术前用药准备、术中神经症状观察、术后并发症的观察与监测及出院指导。结果13例病人均成功置入支架，临床症状改善，未发生严重并发症。结论颈动脉支架置入术治疗颈动脉狭窄损伤小，恢复快，成为治疗颈动脉狭窄的主要方法。规范的围手术期护理对提高手术成功率和远期生存质量至关重要。     

椎-基底动脉重度狭窄的血管内治疗

目的回顾性分析椎-基底动脉重度狭窄患者临床诊断与治疗经过,以评价血管内支架成形术的可行性和临床疗效。方法16例椎-基底动脉重度狭窄患者均施行血管内支架成形术,观察其技术成功率、围手术期并发症发生率及远期疗效。结果16例患者经脑血管造影检查共发现27个狭窄病变,共成功植入36枚球囊扩张式支架,技术成功率达100%(16/16)。1例于手术后24h发生支架内急性血栓形成,围手术期并发症发生率为6.25%(1/16)。随访期间,3例(18.75%)发生支架内再狭窄而致卒中再发。结论血管内支架成形术治疗椎-基底动脉重度狭窄,在技术上可行,远期疗效良好。     

前后循环动脉重度狭窄Ⅰ期支架成形术体会

目的探讨前后循环动脉狭窄同期行血管内支架成形术的手术方法、疗效及安全性。方法对2006-06—2011-02我院16例症状性颈内动脉狭窄同时合并椎基底动脉系统狭窄的患者Ⅰ期行颈动脉及椎基底动脉血管内支架成形术,总结手术经验,观察围手术期并发症,分析临床效果。结果 16例患者共置入34枚支架(其中1例患者同时合并锁骨下动脉狭窄,Ⅰ期行颈动脉、锁骨下动脉、椎动脉支架植入术),术后即刻造影残余狭窄<18%,颈动脉支架置入后9例出现心率下降,11例出现心率、血压同时下降,围手术期未出现动脉夹层、支架内血栓形成以及术后过度灌注脑出血等并发症。术后9例临床症状完全消失,7例明显改善,随访5～24个月,1例术后1a复出现缺血症状,复查DSA提示椎动脉支架内再狭窄,再次给予支架内成形术,症状消失。结论前后循环动脉狭窄同期行血管内支架成形术是一种安全有效的方法,能够降低医疗费用,避免二次手术创伤,但远期效果尚需进一步探讨。     

颈动脉支架置入术围手术期护理体会

目的探讨支架治疗重度颈动脉狭窄病人的围手术期护理。方法 13例重度颈动脉狭窄的病人在支架治疗围手术期内行常规护理,包括心理护理、术前用药准备、术中神经症状观察、术后并发症的观察与监测及出院指导。结果 13例病人均成功置入支架,临床症状改善,未发生严重并发症。结论颈动脉支架置入术治疗颈动脉狭窄损伤小,恢复快,成为治疗颈动脉狭窄的主要方法。规范的围手术期护理对提高手术成功率和远期生存质量至关重要。     

血管内支架成形术治疗症状性椎-基底动脉狭窄

症状性椎-基底动脉狭窄患者的预后极差,即使采用积极的药物治疗,患者每年由于缺血性卒中的死亡及永久致残率仍高达10%左右[1].椎-基底动脉狭窄的血管搭桥手术不仅操作难度大、创伤大,而且并发症发生率高,文献报道围手术期的病死率可达30%[2-3].随着新型血管内支架的研制和神经介入技术的发展,采用支架置入血管成形术渐渐成为椎-基底动脉狭窄的主流治疗方法,作者行血管内支架成形术治疗26例椎-基底动脉狭窄患者,现总结如下.     

改良的预扩张技术置入Wingspan支架治疗大脑中动脉狭窄

目的探讨改良的预扩张技术置入Wingspan支架治疗大脑中动脉狭窄的可行性、有效性及安全性。方法 2007年4月至2010年7月Wingspan支架置入治疗经药治疗无效的大脑中动脉狭窄(>50%)患者48例(其中1例双侧大脑中动脉狭窄)。根据不同预扩张技术,将其分成两组:A组(标准预扩张技术)和B组(改良的预扩张技术)。比较两组治疗效果、术后并发症、复发卒中和再狭窄发生率,并对其风险因子进行多元回归分析。结果本组成功率98%(48/49),最初终止事件包括1例小卒中和2例短暂脑缺血发作。A组狭窄度由(77.11±10.09)%降至(27.50±6.91)%,B组由(72.56±10.46)%降至(8.20±5.41)%。43例患者术后随访5～26个月,平均(12.92±5.08);A组和B组再狭窄率分别是44.4%(8/18)和12.0%(3/25),两组差异显著(P<0.05)。多元回归分析示再狭窄与残留狭窄和糖尿病有关。结论 Wingspan支架治疗大脑中动脉狭窄成功率较高和手术并发症发生率较低,改良预扩张技术可降低残留狭窄程度和再狭窄率。     

A single-center study of Wingspan stents for symptomatic atherosclerotic stenosis of the middle cerebral artery

The middle cerebral artery (MCA) is one of the most common sites of symptomatic intracranial atherosclerosis. We assessed the safety and efficacy of the Wingspan stent (Boston Scientific, Natick, MA, USA) for the treatment of symptomatic atherosclerotic MCA stenosis. Sixty-one patients with symptomatic MCA stenosis with narrowing of at least 70% among 61 patients were treated using Wingspan stents from March 2007 to December 2010. Clinical outcomes and imaging features were recorded and analyzed. The technical success rate was 98.4%. The rate of procedure-related complications during the periprocedural period (30 days) was 5.0% (three of 61 patients), which included one ischemic complication and two hemorrhagic complications with no permanent neurological sequelae. The mean degree of stenosis decreased from 76.8 ± 6.0% to 12.0 ± 11.5% following treatment. Forty-five patients (74%) were available for follow-up imaging with digital subtraction arteriography. In-stent restenosis (ISR) was documented in seven of these patients. A total of 61 patients were available for a clinical follow up. Four ischemic events (6.6%) occurred during the follow-up period, which were all transient ischemic attacks including two symptomatic ISR. The cumulative probability of an adverse event was 11.7% at 1 year. Of the 61 patients, 51 (83.6%) had their follow-up visit more than 12 months after the procedure, and no adverse events were found beyond 12 months after the procedure. Percutaneous transluminal angioplasty and stenting of the MCA was safe and associated with a low periprocedural complication rate. It may result in a good long-term benefit. Prospective randomized controlled trials and further long-term follow up are needed to provide more adequate statistical evidence to support our findings.     

血管内再通术治疗症状性慢性大脑中动脉闭塞的初步临床观察

目的初步观察血管内再通术治疗症状性慢性大脑中动脉闭塞的临床疗效。方法纳入24例2019年1—12月郑州大学人民医院脑血管介入治疗中心采用血管内再通术治疗的症状性慢性大脑中动脉闭塞患者,回顾性观察血管再通的成功率、围手术期并发症的发生率及短期随访结果。结果24例患者中,20例(83.3%)血管成功再通,其中脑梗死溶栓治疗分级(TICI)2b级者6例,3级者14例;4例(16.7%)血管再通失败。共6例(25.0%)发生手术相关并发症。其中20例血管再通成功的患者中,发生蛛网膜下腔出血2例,高灌注脑出血1例,3例患者均行保守治疗,术后2周内出血均吸收,未遗留神经功能缺损症状;1例患者血管再通成功后突发心脏骤停死亡。4例血管再通失败的患者中,血管破裂1例,血管夹层1例。23例患者的术后随访时间为(5.0±1.3)个月(3~6个月)。20例血管再通成功的患者中,2例蛛网膜下腔出血者再通血管再次闭塞,末次随访时临床症状再发;其余患者无缺血症状再发,但影像学证实与术后即刻比较,1例血管狭窄率为42%,4例血管狭窄率≤10%。4例血管再通失败的患者脑缺血症状均再发。结论在严格掌握适应证的情况下,采用血管内再通术治疗症状性慢性大脑中动脉闭塞是可行的,相对安全;在短期内可改善患者的临床症状,但有再闭塞的风险;远期疗效需进一步观察。     

症状性颅内动脉狭窄的支架治疗

目的探讨Wingspan支架治疗症状性颅内动脉狭窄的安全性、可行性和临床疗效。方法应用Wingspan支架治疗90例症状性颅内动脉狭窄患者,观察其手术技术成功率、围手术期并发症,以及术后6个月时脑血管造影显示的支架内再狭窄率。结果 90例患者手术技术成功率约为98.92%(92/93)。术前平均狭窄率为(83.42±9.53)%,术后残余狭窄率为(21.82±9.86)%,手术前后比较差异具有统计学意义(t=3.280,P=0.002)。共5例发生围手术期并发症,约占5.56%(5/90),3例死亡;术后6个月时再狭窄发生率约为19.10%(17/89)。结论 Wingspan支架植入术治疗症状性颅内动脉狭窄具有较高的手术技术成功率、较低的手术并发症及较好的近期疗效,尚待进一步观察患者远期疗效。     

颅内动脉狭窄支架成形术临床相关性因素评估研究

目的探讨颅内动脉狭窄支架成形术的临床应用和相关并发症的影响因素。方法22例25支颅内大动脉段狭窄,行血管内支架成形术。其中大脑中动脉（MCA）15支,椎动脉（VA）5支,基底动脉（BA）3支和颈内动脉（ICA）2支。21支血管（MCA14支,BA2支,VA3支和ICA2支）为症状性重度狭窄、1支（BA）为无症状性重度狭窄;3支血管（MCA1支和VA2支）为症状性中度狭窄。比较评价支架成形术相关性效／损比、总体预后等方面的临床影响因素。结果技术成功率96％（24／25）,手术死亡率0％,未发生再灌注损伤,9例随访者（6～27个月）无再狭窄;所有患者均无手术相关性并发症。结论对于具有治疗适应证的颅内动脉狭窄实施支架成形术是有效和安全的,但远期预后还有待于进一步评估。     

腔内支架成形术治疗症状性基底动脉狭窄

目的 报告应用腔内支架成形术治疗基底动脉狭窄的初步经验。方法 14例基底动脉狭窄患者应用球囊膨胀支架行腔内成形术治疗。结果 9例恢复正常管径,5例狭窄程度减少80％以上,无手术相关并发症。所有患者均恢复满意,无TIA再发作或中风;8例影像学随访6-12个月,均无血管再狭窄。结论腔内支架成形术治疗基底动脉狭窄的早期结果是令人满意的,但需要远期的临床及影像随访结果。     

Percutaneous transluminal angioplasty for symptomatic middle cerebral artery stenosis: long-term follow-up

BACKGROUND AND OBJECTIVE: Although percutaneous transluminal angioplasty (PTA) is an effective treatment modality in the coronary and peripheral arterial diseases, its efficacy for intracranial atherosclerotic stenosis has not been verified. We assessed the long-term outcome of PTA for symptomatic middle cerebral artery (MCA) stenosis. METHODS: We performed PTA in 10 patients with symptomatic high-grade stenosis (>70%) on M1 segment of MCA, who had either recurrent transient ischemic attacks (TIAs) resistant to medical therapy or perfusion problems. PTA was performed with a microballoon (2-2.5 mm diameter and 10-13 mm length) without insertion of a stent. After PTA, we evaluated the possible occurrence of restenosis, which was defined as >50% stenosis on follow-up conventional angiogram or increased M1 flow velocity on follow-up transcranial doppler up to the baseline value. RESULTS: PTA was successfully performed in 9 patients without any serious complications. One patient had asymptomatic dissection. Residual stenosis was less than 50% in diameter in all the patients. During follow-up period (mean 34.5 months), TIAs did not recur in 6 of 7 patients who had had intractable TIAs. Two patients developed strokes, which were not referable to the index MCA lesions. Among the 6 patients who underwent follow-up conventional angiography or serial TCD, restenosis was noticed in 3 patients (50%). CONCLUSION: Although restenosis is not uncommon, PTA for symptomatic MCA stenosis is a relatively safe procedure, and can be used to prevent recurrent TIAs or strokes in selected patients.     

症状性双侧颈内动脉C1段狭窄血管内支架治疗

目的探讨症状性双侧颈内动脉C1段重度狭窄血管内支架治疗安全策略。方法收集我院2007年5月至2010年6月经全脑血管造影诊断的经血管内支架治疗的症状性单纯性双侧颈内动脉C1段重度狭窄的12例病例,依据支架治疗策略分为:分次治疗组、同时治疗组、单侧治疗组。结果共收集符合入选标准的病例12例、男性9例,年龄52-78岁,平均65.3±13.9岁,分次治疗组7例、同时治疗组4例、单侧治疗组1例,平均随访时间依次为25个月、16个月、18个月。围手术期并发症情况:术中心率减慢事件分次组发生2次(7例)、同时组发生3次(4例)、单侧组发生0次(1例);术中低血压事件分次组发生0次(7例)、同时组1次(4例)、单侧组0次(1例);同时治疗组出现1例无新神经功能缺损的出血性卒中,各组均未发生死亡事件。颈动脉B超随访均未见明确的支架内再狭窄,分次组中有1例于术后1年采用血管造影复查诊断支架内20%的弥漫性再狭窄,该病例有鼻咽癌及鼻咽部局部放疗病史。结论积极药物治疗基础上3种支架治疗策略均是安全有效的,结合患者个人经济、体质情况可以具体选择;但一次性支架治疗双侧颈内动脉重度狭窄性病变时,脑过灌注损伤风险加大,同时术中使用心脏临时起搏器是必要的。     

Embolism in acute middle cerebral artery stenosis

OBJECTIVE: To investigate the frequency of middle cerebral artery (MCA) stenosis in a series of nonselected patients and the coexistence of microembolic signals with stenosis. METHODS: MCA stenosis was sought by transcranial Doppler (TCD) in 387 patients admitted consecutively with acute ischemic cerebrovascular disease within the first 48 hours of the onset of symptoms and again at 6 months. TCD monitoring for microembolic signals was performed on all patients with MCA stenosis. RESULTS: MCA stenoses were found in 29 patients (7%), although in only 20 patients (5%) was the stenosis symptomatic. Microembolic signals were detected in five of 14 symptomatic stenoses (36%) monitored at the acute phase, but none were found in the chronic phase or in asymptomatic stenosis. Despite one third of symptomatic patients having had a further source of emboli, microembolic signals were detected only distally to the MCA stenosis. In the symptomatic group, 25% of stenoses had completely disappeared 6 months after stroke. Microembolic signal detection at the acute phase was associated with the subsequent disappearance of the stenosis. CONCLUSIONS: The frequency of symptomatic MCA stenosis in acute ischemic stroke was 5% in the population studied. Many stenoses are transient, and microembolic signals are often detectable at the poststenotic segment in the acute phase. The origin of at least 25% of symptomatic acute MCA stenoses may be embolic rather than atherosclerotic.     

12例椎-基底动脉串联病变的血管内治疗探讨

目的探讨经皮血管内支架成形术(PTAS)治疗椎-基底动脉重度狭窄串联病变的有效性、安全性及可行性。方法对12例(26处)经药物治疗无效的症状性椎-基底动脉串联病变患者采用经皮血管内支架成形术治疗。术前DSA示动脉直径狭窄率为65～100%,平均84.62±8.24%。结果本组支架置放成功率92.6%,术后平均狭窄率为16.92±14.84%;术后用mRS量表(改良RANKIN量表)评分,7例0分,3例1分,2例3分。发生2例围手术期并发症,年卒中率为6.2%;随访期间2例发生支架内再狭窄。结论血管内支架成形术治疗椎-基底动脉串联病变,在技术上可行,远期疗效良好。