缺血性脑卒中患者颈部血管狭窄的诊断及介入治疗

目的探讨山西长治地区缺血性脑卒中患者颈部血管狭窄的诊断及介入治疗情况。 方法对山西长治市人民医院神经内科2008年1月至2013年12月所有住院的急性缺血性脑卒中患者，先采用非创伤性检查筛查出颈部血管狭窄患者，征得患者同意后行数字减影血管造影(DSA)检查，确诊颈部血管狭窄符合介入治疗指征的缺血性脑卒中患者，根据患者最终是否接受介入治疗分为介入治疗组及非介入治疗组(对照组)。分别于出院后3、6个月，1、2年进行随访，了解疾病复发情况，采用改良RanKin量表进行评分(MRS)以评估患者生存质量，并比较两组患者差异。 结果共筛查出可疑颈部血管狭窄患者72例，DSA造影显示：颅外颈内动脉狭窄31例，椎动脉狭窄14例，锁骨下动脉狭窄13例；颅内颈内动脉系统狭窄10例，颅内椎基底动脉系统狭窄17例；其中多发狭窄25例。36例颅外颈部血管狭窄符合介入治疗适应证，其中16例接受介入治疗(治疗组)，20例未接受介入治疗(对照组)。在所有接受介入治疗的患者中，接受颅外颈部血管支架置入术者15例，接受球囊扩张术者1例，介入治疗成功率100%，无严重并发症及死亡病例。与对照组相比治疗组患者复发次数明显减少(χ²＝8.23，P＝0.004)，生存状态更好(χ²＝8.22，P＝0.004)。 结论山西长治地区缺血性脑卒中患者，脑动脉狭窄前循环脑梗死的血管病变，以颈内动脉起始部狭窄为主；后循环脑梗死的颅外血管病变，以椎动脉起始部位狭窄为主，其次是锁骨下动脉起始部狭窄致锁骨下动脉盗血，另外后循环脑梗死的血管病变中颅内椎动脉狭窄也不少见。

Interventional diagnosis and therapy on ischemic stroke with extracranial carotid artery stenosis

ObjectiveTo explore and discuss the interventional diagnosis and therapy of ischemic stroke with extracranial carotid artery stenosis in Changzhi district Shanxi Province. MethodsPatients with acute ischemic stroke from January 2008 to December 2013 were recruited in Department of Neurology in Changzhi People′s Hospital Shanxi Province.Patients with carotid stenosis were screened out by noninvasive examination firstly, then given DSA to confirm the diagnosis after the consent of the patients.Patients with interventional therapy indication were distributed into intervention group and non-intervention group. All the patients′ neural function were evaluated with NIHSS score before treatment, and followed up at 3 months, 6 months, 1 year and 2 years respectively after discharge.The recurrence was observed, and Modified RanKin Scale score (MRS) was used to evaluate the survival quality. ResultsSeventy-two patients with suspitious cervical angiostenosis were detected DSA in total.The results suggested that 31 had stenosis in extracranial caroti, 14 in vertebral artery, 13 in subclavian artery, 10 in intracranial intracervical artery system and 17 in intracranial vertebrolbasilar system. Among the patients, 25 had multiple stenosis. Thirty-six patients conformed to the indications of intervention therapy in total, which 16 received intervention therapy(treatment group) and 20 cases as control (the control group). Among all the sixteen patients, fifteen stent placement and one balloon dilatation were performed, without any serious complication or death. Compared with control group, patients in the interventional therapy group had lower recurrence rate(χ²=8.23, P=0.004), and were in better functional status(χ²=8.22, P=0.004). ConclusionsIn Changzhi district, the vasculopathy of anterior circulation infarction mainly occurs as stenosis at the initial part of internal carotid artery.The posterior circulation infarction mainly occurs at initial part of vertebral artery, then as the subclavian steal syndrome at the initial part of the subclavian artery.Stenosis of intracranial vertebral artery is also common in posterior circulation infarction. Based on strictly therapeutic indications, intervention therapy was related with a better prognosis in ischemic stroke patients with extracranial carotid artery stenosis.