颈动脉扭曲的血管内治疗

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。

Carotid angioplasty and stenting for symptomatic carotid kinking combined with stenosis

Background Carotid endarterectomy （CEA） is currently the preferred treatment for severe carotid kinking and stenosis. Kinking is generally believed to be a relative contraindication for endovascular stent placement. This article aims to study the necessity, feasibility and security of carotid angioplasty and stenting （CAS） for symptomatic carotid kinking combined with stenosis, and summarize clinical experience of this disease according to therapeutic results. Methods Twenty-two cases with symptomatic carotid kinking and high-grade stenosis demonstrated by digital subtraction angiography （DSA） were performed CAS. Their clinical manifestations, imaging features, procedure safety and follow-up data were collected and retrospectively analyzed. All patients understood CEA and voluntarily received CAS. Results Twenty-two cases with carotid kinking and stenosis were all successfully performed CAS （the success rate was 100%） without stent-related disability or mortality. Twenty-four self-expandable stents were implanted. The mean degree of stenosis was reduced from 85.63% before stenting to 11.25% after stenting and the angles of kinking were improved from 〈 90 to 〉 120 （Metz category）. During the period of hospitalization, no transient ischemic attack （TIA） or cerebral infarction occurred, and the clinical symptoms and signs of ischemia, such as dizziness and headache, were improved or disappeared. Besides, no permenant complications or deaths happened. All cases were followed up from 6 to 72 months, among whom 1 patient experienced contralateral carotid TIA, and 2 patients experienced ipsilateral carotid TIA （one indicated aspirin resistance in platelet aggregation test and the other showed restenosis in DSA）. Computed tomography angiography （CTA） of 10 patients and Duplex scan of 7 patients during the follow-up demonstrated carotid in good morphology and fluent blood flow, without kinking or restenosis.Conclusion CAS is a feasible and safe therapeutic method and maybe helpful to lower the risk of cerebral ischemia for the patients with symptomatic kinking and stenosis. However, further study is still needed.