颈动脉狭窄血管内支架治疗并发症的临床分析

目的 探讨颈内动脉狭窄血管内支架治疗的并发症。方法 对478例颈内动脉狭窄患者行全脑血管造影及颈部超声检查。对195例患者使用脑保护装置，在未使用保护装置的283例患者中，对202例患者采用预扩张，占71．4％；66例采取后扩张，占23．3％；12例采用球囊扩张式支架，占4．2％；3例未扩张，占1．1％。结果 478例患者技术成功率为100%，患者症状消失或好转率为78．7％。心率＜50次／min者占26．4％；术中栓子脱落5例，其中2例治疗后恢复，2例遗留一侧肢体运动障碍，1例死亡；术后颅内出血死亡1例，术后30d内卒中或死亡6例，占1．26％。随访率为77．8％。再狭窄17例，占4．6％。结论颈内动脉狭窄的血管内支架治疗是安全的，若操作规范，可以减少并发症。

Analysis of complications in percutaneous transluminal stenting for stenosis of internal carotid artery

Objective To discuss the complications of percutaneous transluminal stenting for stenosis of internal carotid artery. Methods 478 patients with ICA stenosis were included from 1997 to 2004.All of them took periprocedual anticoagulation treatment, cerebral vascular angiograpgy and cervical Dopller sonography. 195 patients used cerebral protection of filter devices. Among the 283 patients without cerebral protection,202 patients(71.4%) underwent predilation ;66 patients(23.3%) underwent postdilation;3 patients underwent neither. Results Technical success was achieved in all patients(100%). Heart rate was decreased in 25.0% of all the patients (under 50/min). Dislodgment of thrombotic or plaque debris happened in 5 patients during the procudure, 2 of them improved after treatment . 2 of them got dyskinesias of one side,and 1 patient died . 1 patient died of intracerebral hemorrhage(ICH) after the procedure. Stroke and death occurred in 6 patients (1.26%)within 30 d after operation.322 patients(77.8%) were followed up. Restenosis occurred in 17 patients(4.6%). Conclusion Percutaneous transluminal stenting is safe for treatment stenosis of internal carotid artery if operative procedure and periprocedual treatment are standardized,and do the best to prevent periprocedual complications.