颈动脉支架植入术安全性、难点及处置的探讨

目的探讨颈动脉支架植入术(CAS)操作的安全性、技术难点及难治病例的处置方法.方法回顾79例行颈动脉支架植入术者的临床资料,并分析CAS的安全性,复习近年来国内外的相关资料.分析CAS操作中栓子来源及影响CAS安全操作的因素.针对操作难点实施三套管法、释放过程中调整支架位置的方法及对支架进行选择的方法等.结果手术成功的75例患者共放置支架78个,总的成功率为94.9%.术中应用脑保护装置54例,其中并发严重卒中2.67%;循环系统并发症发生率为13.89%.结论在应用脑保护装置的条件下,正规熟练的操作、严格的预防措施可使CAS的并发症发生率降到最低.

The safety of carotid stent placement: nodus and managements

Objective To investigate and summarize the safety and difficulties in the technique of carotid angioplasty and stent placement !CAS and to discuss the disposal of cases that were difficult to treat. Methods 78 cases that had CAS in our clinic were included and the literatures were reviewed we then summarized our view about safety of CAS. In addition, we analyzed the source of thrombus in CAS and probed the factors that influenced the safety of CAS. Aiming to the difficulties in CAS, we carried out some modified techniques, we named them as "tri-cannula", "adjusting stents position during release" and "selecting the suitable stents"etc. Results 78 stents were released in 75 CAS cases, 94.9% were successful. Brain-protected safeguard were used in 54 cases during operation. 2.78% of all cases suffered from serious brain block and 13.89 % had cardiovascular complications. Conclusions After using Brain-protected safeguard, the incidence of serious brain attack of CAS was similar to that of CES. We thought that the complications of CAS could be minimized by taking regular and skilled techniques and implement strict preventive measures. We believe that improved techniques can increase the success rate of CAS and proficiency in manipulation can decrease the incidence of complications.