颈动脉内膜剥脱术治疗缺血性脑血管病临床分析

目的探讨颈动脉内膜剥脱术治疗缺血性脑血管病的临床疗效及安全性。方法回顾性总结2009年1月至2013年12月期间33例颈动脉硬化狭窄或闭塞而行颈动脉内膜剥脱术患者的临床资料。结果 33例手术均顺利完成。围手术期内发生声音嘶哑1例,伤口血肿2例,喉头水肿1例,均经对症治疗后症状缓解,围手术期无死亡病例。随访6~48个月,31例患者术后恢复良好,脑缺血症状有不同程度改善,并且在术后随访中均未出现脑卒中。4例颈动脉完全闭塞患者,手术后2例颈动脉血流再通。术后均行颈动脉CT动脉造影检查,31例证实颈总动脉和颈内动脉血流量明显增加。结论颈动脉内膜剥脱术是治疗颅外颈动脉狭窄或闭塞,预防脑梗死,改善脑供血安全有效的方法。     

冠状动脉旁路移植同期行颈动脉内膜剥脱术12例

目的:探讨冠心病合并颈动脉狭窄患者同期行冠状动脉旁路移植和颈动脉内膜剥脱术的临床效果.方法:选择冠心病并颈动脉狭窄的12例,在全麻下先行颈动脉内膜剥脱,颈动脉内膜剥脱结束后同期行非体外循环下冠状动脉旁路移植术.结果:本组均行单侧颈动脉内膜剥脱及冠状动脉旁路移植术,每例平均冠状动脉移植3.3支.全组围术期无死亡,无脑梗死发生.1例术后出现颈部切口血肿,1例术后出现谵妄.术后3个月～1年复查未发现脑梗死和短暂性脑缺血发作,4例有慢性脑缺氧症状者均不同程度好转,全组无心绞痛和心肌梗死发生,颈动脉超声再血管化部位血流通畅.结论:冠状动脉旁路移植同期行颈动脉内膜剥脱术安全、有效,严格把握手术适应证和科学规范的外科操作是取得良好手术效果的关键.     

颈动脉内膜剥脱术治疗脑缺血19例分析

目的 总结颈动脉内膜剥脱术的治疗经验，进一步提高颅外段颈动脉狭窄病变尤其是双侧重度颈动脉狭窄病变的治疗水平。方法 1996年6月至2004年4月对19例重度颈动脉硬化狭窄所致的脑缺血性患者实施了颈动脉内膜剥脱术。结果 19例中有3例术中发生一过性脑缺血，另外死亡1例，其余恢复顺利。平均25个月的随访发现1例剥脱术后再狭窄。结论 颈动脉内膜剥脱术至今仍是颈动脉狭窄病变治疗的金标准，对双侧重度的狭窄病变，应用颈动脉转流是预防术中脑缺血的重要措施。     

颈动脉内膜剥脱术早期临床疗效分析

目的 评价颈动脉内膜剥脱术治疗颈动脉粥样硬化性狭窄的早期临床效果.方法 回顾性分析20例行颈动脉内膜剥脱术颈动脉粥样硬化患者临床资料,记录术前及手术后6个月颈部及大脑中动脉血管血流峰值,并比较手术前、后临床症状评分.结果 术后患者颈动脉血流峰值及大脑中动脉收缩期血流峰值与术前比较差异有统计学意义(P＜0.05),术后颈动脉狭窄引起的缺血性症状得到明显改善.结论 颈动脉内膜剥脱术治疗颈动脉粥样硬化性狭窄早期疗效显著.     

颈动脉内膜剥脱术26例

目的总结26例颈动脉内膜剥脱术的经验。方法回顾分析2004年6月～2005年12月在我院行颈动脉内膜剥脱术26例病历资料：结果全组患者无围术期死亡、脑梗死等不良事件发生。结论颈动脉内膜剥脱术是治疗颅外颈动脉狭窄、脑梗死后遗症及预防脑梗死、改善脑供血的安全、有效方法。     

颈动脉内膜剥脱术治疗颈动脉狭窄12例疗效观察

目的 探讨颈动脉内膜剥脱术治疗颈动脉粥样硬化性狭窄的疗效.方法 分析手术治疗的12例颈动脉硬化性狭窄患者的临床资料,探讨其手术适应证、手术要点、围手术期处理.所有患者明确颈动脉狭窄程度达70%～90%,术中放置颈动脉转流管,常规使用肝素抗凝,术后药物控制血压及监测生命体征.结果 2例术后8～10 d发生脑出血再手术,1例术后死亡.其他患者恢复良好,术后彩色多普勒超声检查提示颈动脉通畅.结论 颈动脉内膜剥脱术治疗颈动脉粥样硬化性狭窄,是一种简单、较为安全的方法.术中精细操作、合理使用转流管、术后药物控制血压、监测生命体征可以减少术后并发症的发生.     

颈动脉内膜剥脱术治疗颈动脉狭窄的围术期护理

颈动脉狭窄主要原因是颈总动脉分叉处或颅内动脉起始处动脉粥样硬化[1],即颈动脉壁形成斑块,当这些斑块增大或破裂时,就会造成颈动脉狭窄或栓塞,使远端灌注压下降,导致低灌注性脑梗死.动脉粥样硬化所致的颈动脉狭窄多见于中、老年人,常伴存着多种心血管危险因素.颈动脉内膜剥脱术(Carotid endarteretomy,CEA)作为治疗颈动脉硬化狭窄,预防脑中风的标准手术方法,已经被欧美等国家大规模的临床试验所肯定[2].现将我科2007年5月～2012年5月成功实施61例颈动脉内膜剥脱术患者的围术期的护理体会总结如下.     

颈内动脉内膜剥脱术1例的手术配合

颈动脉狭窄是由于颈动脉内膜产生了粥样硬化性斑块,从而导致动脉管腔狭小,病变常累及颈总动脉分叉部及颈内动脉,及时外科治疗有助于降低患者脑梗死危险,改善脑血供,提高生命质量。颈动脉内膜剥脱术（carotid endarterectomy,CEA）是将颈内动脉内膜切开并剥离增厚的内膜而使血管再通的手术。本院于2009年2月成功地施行第1例颈内动脉内膜剥脱术,现将手术配合报告如下。     

14例双侧中重度颈动脉狭窄患者分期行颈动脉内膜剥脱术治疗策略

目的:探讨双侧颈动脉狭窄行颈动脉内膜剥脱术治疗策略。方法:分析14例双侧中重度颈动脉狭窄患者,11例先后行双侧颈动脉内膜剥脱术,3例行单侧手术,于围手术期行头部MRI、头颈部TCD、头颈部CTA+CTP,分析术前术后脑血流动力学变化和血压变化。术前术后采取m RS评价神经功能。结果:14例患者均成功行颈动脉内膜剥脱术,2例于术后2 d内发生脑过度灌注综合征,1例伤口感染。术后患者m RS评分低于术前(P<0.05)。结论:CEA可有效治疗双侧颈动脉狭窄,围手术期血流动力学和血压是影响手术效果重要因素。     

颈动脉内膜剥脱术治疗颈动脉狭窄性脑缺血性疾病

目的：探讨颈动脉内膜剥脱术的手术指征、手术方法及围手术期的处理。方法：回顾性分析5例颈动脉狭窄患者的临床资料。结果：5例患者术后恢复满意，1例出现术野血肿，2例出现一过性声音嘶哑，1例出现听力减退，1例出现头晕。结论：颈动脉内膜剥脱术安全有效，术前、术中抗凝治疗可降低并发症的发生。     

Carotid artery stenting versus carotid endarterectomy in the treatment of symptomatic and asymptomatic carotid stenosis: a systematic review and meta-analysis

Purpose: To evaluate the short-term and intermediate- to long-term efficacy and safety of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA).Materials and Methods: The published literature was electronically searched for randomized controlled trials (RCTs) between CAS and CEA for the treatment of carotid stenosis performed from January 2000 to January 2017. The short-term and intermediate- to long-term outcomes were evaluated.Results: We identified 10 RCTs including 7,183 participants with symptomatic or asymptomatic carotid stenosis. Our meta-analysis found different results between the patients with and those without symptoms. In patients with symptomatic carotid stenosis, the total stroke incidence in the CAS group was significantly higher than that in the CEA group within the 30-day periprocedural period (p<0.001); however, the myocardial infarction incidence in the CAS group was significantly lower than that in the CEA group (p<0.05). There was no significant difference between the two groups in the mortality within 30 days post-procedure, but the intermediate- to long-term incidence of stroke or death in the CAS group was higher than that of the CEA group (p<0.05). In contrast, for asymptomatic patients, there were no significant differences between the CAS and CEA groups in the short- and intermediate- to long-term outcomes.Conclusion: For patients with symptomatic carotid stenosis, CEA is associated with an increased risk of myocardial infarction, whereas CAS is correlated with an increased risk of procedurally related strokes. However, for patients with asymptomatic carotid stenosis, no significant difference was found in the efficacy or safety between CAS and CEA.     

滤网保护下支架置入术治疗颈动脉狭窄的临床观察

[目的]探讨颈动脉狭窄的病因及滤网保护下支架置入术治疗颈动脉狭窄的临床疗效.[方法]对26例颈动脉狭窄患者施行滤网保护下支架置入术,分析颈动脉狭窄的常见病因及颈动脉支架置入术的有效性和安全性.[结果]既往有高血压病8例,高血压病伴糖尿病9例,高血压病伴冠心病6例,2例有高脂血症.男性患者中有13例长期吸烟病史,女性患者均无吸烟史.支架放置均准确,21例颈动脉狭窄管径基本恢复到正常,4例仅遗留20%狭窄,1例遗留40%狭窄,6例术中术后出现血压下降、心动过缓,无其他并发症发生.[结论]男性、高血压病、长期吸烟（吸烟指数约800）可能是颈动脉狭窄的重要危险因素,滤网保护下血管内支架置入术治疗颈动脉狭窄是一种安全、有效的方法.     

Carotid artery stenting: it's all about appropriate patient selection and keeping to the indications

With increasing carotid artery stenting (CAS) expertise and improved CAS equipment, recent trials have demonstrated better results for CAS compared with earlier studies. As a result, it may be argued that CAS is currently non-inferior to carotid endarterectomy (CEA), at least in some patient subgroups. Consequently, there have been recent calls for extending CAS indications to include average surgical risk patients with symptomatic or asymptomatic carotid stenosis. However, CAS remains a less cost-effective option than CEA. Opening the floodgates to unrestricted CAS for both symptomatic and asymptomatic carotid patients would have considerable cost implications for any health system. Appropriate patient selection and keeping to the indications are crucial to optimize CAS outcomes.     

Characteristic Sonographic Findings of Early Restenosis After Carotid Endarterectomy

Objective. Restenosis of the carotid artery after carotid endarterectomy (CEA) is a major complication. The frequency, time of occurrence, and tissue characteristics of carotid restenosis were assessed with sonography. Methods. Two hundred sixteen patients who had CEA for carotid stenosis were studied; follow‐up sonography and magnetic resonance angiography were done 2 weeks, 3 months, and then every year after CEA. On sonography, restenosis was defined as an internal carotid artery (ICA) with a peak systolic velocity of 170 cm/s or greater or a maximum area of stenosis of 90% or greater. Results. During 605 artery‐years of follow‐up, 18 patients (7.5%) were found to have restenosis on sonography: 4 at 3 months, 11 at 1 year, and 3 at 2 years after CEA. At the time that restenosis was detected, in all 18 ICAs the peak systolic velocity exceeded 200 cm/s and had more than doubled since the last measurement (mean ± SD, 103 ± 27 to 321 ±107 cm/s), whereas the area of stenosis exceeded 90% in 6 patients, and magnetic resonance angiography revealed stenosis of 60% or greater in 8 patients. On sonography, all of the restenotic plaques were isoechoic and concentric. The restenosis was asymptomatic in 17 patients. Vascular risk factors or the severity of initial carotid stenosis before CEA were not associated with development of restenosis. Eleven patients had successful endovascular therapy, and the others received medical treatment. Conclusions. A marked increase in the flow velocity through an operated ICA is a good indication of restenosis. The isoechogenicity and concentricity of the restenotic plaques suggest that the restenosis is primarily the result of intimal hyperplasia.     

颈动脉狭窄患者颈动脉内膜剥脱术前后血流动力学的改变

目的观察颈动脉狭窄患者实施颈动脉内膜剥脱术手术前后血流动力学改变的规律，为临床护理提供依据。方法对实施颈动脉内膜剥脱术的患者，于术前7d、3d、1d每日晨和术后1周进行血流动力学的监测，对术前、术后血流动力学指标进行统计学分析。结果患者自身术前SBP、DBP、MBP对比，患者术后SBP、DBP、MBP对比，手术前后心率、手术前后呼吸分别进行对比，P均〉0．05，无统计学意义；手术前后SBP、DBP、MBP对比、手术前后心律对比，P均〈0．01，有统计学意义；并且手术后71．0％的患者SBP、DBP、MBP呈现升高趋势，38．7％的患者术后出现心律不规则，心律变化由大变小逐渐趋于正常。结论颈动脉狭窄患者手术后血流动力学变化明显，手术后应注重血流动力学的监测，以预防并发症的发生。     

Carotid artery stenting will replace carotid endarterectomy

Stroke is the third leading cause of death in the United States. Carotid artery stenosis represents one of the most common etiologies of stroke. The current treatment modalities available for the treatment of carotid artery stenosis are carotid endarterectomy (CEA) and carotid artery stenting (CAS). Several clinical trials comparing CEA with medical management showed superiority of the surgical arm; however, the applicability of these results to the general population is limited by the fact that the patients and surgeons enrolled in these trials were carefully selected, and the optimal medical therapy used does not meet the current treatment standards. Carotid artery stenting has emerged as a treatment alternative to CEA, as shown in randomized trials comparing the 2 treatment modalities. Recent data from large-volume CAS registries indicate that percutaneous treatment of carotid artery stenosis compares favorably to CEA. Furthermore, the CAS trial designs make these results more applicable to the community standards. These data suggest that CAS will become the treatment of choice in patients with carotid artery stenosis.     

Carotid revascularization for prevention of stroke: carotid endarterectomy and carotid artery stenting

Carotid endarterectomy (CEA) has been used for the past several decades in patients with carotid occlusive disease. Large randomized controlled trials have documented that CEA is a highly effective stroke preventive among patients with carotid stenosis and recent transient ischemic attack or cerebral infarction. In asymptomatic patients with carotid stenosis, clinical trial data suggest that the degree of stroke prevention from CEA is less than among symptomatic patients. However, otherwise healthy men and women with an asymptomatic carotid stenosis of 60% or greater have a lower risk of future cerebral infarction, including disabling cerebral infarction, if treated with CEA compared with those treated with medical management alone. More recently, carotid artery stenting has been performed Increasingly for patients with carotid occlusive disease. As technology has improved, procedural risks have declined and are approaching those reported for CEA. The benefits and durability of CEA compared with carotid artery stenting are still unclear and are being studied in ongoing randomized controlled trials.     

Comparison of Carotid Artery Stenting and Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis: A Single Center Study

Introduction

Carotid artery stenting (CAS) is believed to be an alternative to carotid endarterectomy (CEA); however, recent studies have demonstrated an increase of complications with stenting that does not reflect our experience. We thus wanted to compare the periprocedural and 1-year follow-up outcomes of CAS with those of CEA among patients with symptomatic extracranial carotid stenosis in a population from eastern Turkey.

Methods

The hospital records of all patients who underwent carotid artery revascularization were retrospectively reviewed. Patients were divided into two groups based on the type of carotid revascularization performed, namely CEA or CAS. Comparisons were made with respect to 30-day and 1-year outcomes of transient ischemic attack (TIA), myocardial infarction (MI), stroke, and all-cause death rates. Composite endpoints for both groups were also analyzed.

Results

Thirty-two CEA and 33 CAS procedures were performed for symptomatic occlusive carotid disease. Baseline characteristics were similar between both groups except for the incidence of diabetes mellitus. No significant differences were found with respect to 30-day mortality, MI, and neurologic morbidity endpoints for CEA and CAS procedures. In the postprocedural 1-year follow-up, only TIA was observed to be significantly higher in the CAS group; the other endpoints did not differ significantly. One-year composite endpoints did not differ between both groups (log-rank P = 0.300).

Conclusion

In our trial of patients with symptomatic carotid artery stenosis, no significant difference could be shown in periprocedural outcomes, postprocedural outcomes except TIA, and in composite endpoints between the CEA and CAS groups. CAS is a safe and efficacious alternative for the treatment of symptomatic carotid artery stenosis.     

慢性颈动脉粥样硬化闭塞治疗的研究进展

慢性颈动脉粥样硬化闭塞会导致脑血流低灌注而增加卒中风险。无症状患者首选药物治疗,对于反复出现神经症状的患者可选择手术治疗。颅外-颅内动脉旁路术(extracranial-intracranial artery bypass,EIAB)治疗效果不优于药物治疗。颈动脉内膜剥脱术(carotid endarterectomy,CEA)、颈动脉支架成形术(carotidartery stent,CAS)手术风险高、成功率低,治疗效果尚待验证,故术前应严格筛选患者、把握适应证。本文就目前对于慢性颈动脉闭塞的治疗现状作一综述。     

彩色多普勒在颈动脉内膜切除术中的应用

目的:探讨彩色多普勒(CDFI)在颈动脉内膜切除术(CEA)治疗颈动脉狭窄中的临床价值。方法:CEA治疗前经CDFI检查的颅外段颈动脉狭窄患者27例,其中12例患者行数字减影脑血管造影(CAG)检查。结果:CDFI显示40侧颈总或/和颈内动脉内-中膜增厚,34侧伴有斑状强回声,31侧管腔狭窄,程度为40％-95％,中位数是76％;2侧颈内动脉闭塞。CDFI诊断颈动脉狭窄结果与CAG检查比较无显著性差异(P>0.05)。结论:CDFI在显示颅外段颈动脉管壁病变方面有很高的敏感性,并且能准确地判定颈动脉管腔狭窄程度,可作为筛选CEA患者的可靠手段,也能用作CEA患者治疗后随访。