血管支架成形术治疗症状性脑动脉狭窄47例疗效观察

采用血管支架成形术治疗症状性脑动脉狭窄患者47例,结果 手术成功率100%;术后随访6～18个月,未发生新卒中或短暂性脑缺血发作,影像学检查显示均无再狭窄.术中出现一过性心率缓慢、血压下降4例,颅内动脉远端血管痉挛2例;术后第2天出现上消化道出血1例,经治疗后症状均消失.提示血管支架成形术治疗症状性脑动脉狭窄比较安全,短期疗效较好.     

血管内支架成形术在症状性脑血管狭窄治疗中应用的初步探讨

目的 探讨血管内支架成形术治疗症状性脑动脉狭窄的效果及安全性.方法 对33例症状性脑动脉狭窄患者进行了37处血管内支架成形术治疗,其中颈内动脉颅外段狭窄14处,颈内动脉颅内段狭窄3处,大脑中动脉狭窄3处,椎动脉颅外段狭窄13处,椎动脉颅内段2处,锁骨下动脉2处.结果 本组33例患者行37处支架置入术,其中成功置入35枚支架,手术成功率94.59%;1例手术中并发脑血管痉挛,1例手术中并发造影剂过敏,1例手术后并发高灌注综合征.结论 血管内支架成形术治疗症状性脑动脉狭窄是安全有效的,其远期疗效尚待进一步随访观察.     

老年脑血管病患者颈动脉颅外段与颅内动脉狭窄血管内成形术疗效对比

目的 探讨老年脑血管病患者颈动脉颅外段与颅内动脉狭窄血管内成形术疗效.方法 选择老年脑血管病患者36例,其中颅内血管狭窄患者15例,颅外血管狭窄患者21例,患者给予手术治疗,术后随访3年,并行TCD及DSA评价、ASPECTS量表评分,对患者术后并发症进行评估.结果 本组36例老年患者全部支架放置成功,患者术后各项参考指标均显著改善,患者术后1个月、1年、3年的峰值流速、舒张末期流速、平均流速较术前减慢,而脉动指数较术前增高,与术前对比差异有统计学意义(P＜0.05).两组患者手术前后ASPECTS评分中显示患者术后1个月、1年及术后3年的ASPECTS评分与术前对比差异显著(P＜0.05).两组患者行支架治疗后,颅内支架组患者成功14例,失败1例,成功率93.3％.术后脑出血2例,血管痉挛1例,再闭塞2例,心率、血压下降1例.颅外支架组成功20例,失败1例,成功率95.2％.再闭塞1例,心率、血压下降5例.结论 血管内支架成形术可以很好地治疗老年症状性脑动脉狭窄,但相对来说技术要求较高,尤其是颅内血管支架成形术.相对于颅外血管支架成形术,颅内血管支架成形术术后并发症相对较多.     

症状性脑动脉狭窄介入治疗的疗效观察

目的评价症状性脑动脉狭窄血管内支架成形术的安全性及近远期疗效。方法回顾性分析2009年—2010年在我院行颅内外动脉支架成形术的10例症状性脑动脉狭窄病人,就手术安全性及术后近远期临床疗效进行分析。结果本组10例病人,手术成功率达100%,8例病人术后症状消失,2例术后症状好转。随访4个月~18个月,所有病人无卒中临床复发,支架内均无血栓形成或内膜增厚。结论血管内支架成形术治疗症状性脑动脉狭窄比较安全,近期疗效较好,其远期疗效有待于进一步继续追踪观察。     

脑血管造影评估在血管内支架成形术治疗脑供血动脉狭窄中的价值

目的探讨脑血管造影评估在血管内支架成形术治疗脑供血动脉狭窄中的价值。方法对105例症状性脑缺血发作患者进行术前全脑血管造影，对相关影像学信息进行全面评估，根据评估结果对136支狭窄血管行血管内支架成形术，术后不同时期进行脑血管造影随访。结果70处血管狭窄恢复正常血管直径，54处残余狭窄〈20％，7处残余狭窄为50％～80％。5例因支架不能输送到位而放弃手术；术中血栓保护伞完全被封堵1例。患者术前症状均有不同程度缓解。70例患者获得术后1～36个月的脑血管造影随访，颈动脉再狭窄2例，椎动脉起始部再狭窄6例，颅内动脉再狭窄6例。结论 术前充分评估脑血管造影结果并据此制定个体化治疗策略是保证血管内支架成形术安全性的前提。     

Neuroform支架在治疗症状性颅内动脉狭窄中的应用

目的评价使用Neuroform支架在治疗症状性颅内动脉狭窄的安全性、可行性。方法症状性颅内动脉狭窄患者11例,其中前循环狭窄2例(1例狭窄位于颈内动脉眼段交通段,1例狭窄位于大脑中动脉M1段),后循环狭窄9例(3例狭窄位于基底动脉,6例狭窄位于基底动脉交界处);均进行支架成形术治疗,术后全脑血管造影复查及使用美国国立卫生研究院脑卒中量表(NIHSS)进行评定。结果11例患者支架全部置放成功,造影复查显示动脉直径狭窄率从术前(85.6±7.4)%降至术后(35.7±12.1)%。按NIHSS评分评估,11例患者术后症状明显改善,其中1例患者术后15天出现Wallenberg综合征,随访1~12个月,其他患者未出现脑缺血再发作及支架内再狭窄。结论应用Neuroform支架治疗症状性颅内动脉狭窄合并路径血管纡曲不光滑的患者,可以提高手术成功率,减轻临床缺血症状和改善预后。     

Wingspan支架治疗后循环症状性颅内动脉狭窄的疗效

目的 分析Wingspan支架治疗后循环症状性颅内动脉狭窄的临床疗效.方法 回顾分析采用Wingspan支架系统行血管成形术治疗30例后循环症状性颅内动脉狭窄患者的临床资料,观察手术成功率,采用数字减影血管造影(DSA)测定治疗前后狭窄的部位狭窄程度改善情况,观察术后症状及并发症情况.记录随访期间的再狭窄发生情况.结果 手术成功率为100％,动脉狭窄程度由(74.6±13.6)％降为(14.8±4.5)％(t=13.469,P ＜0.01),术后并发症比例为10％,随访期间共计出现5例支架内再狭窄,再狭窄率为16.67％,均为无症状性再狭窄,无患者死亡.结论 Wingspan支架治疗后循环症状性颅内动脉狭窄临床疗效确切,有效改善患者症状、神经功能与预后,是一种安全、有效的方法.     

Enterprise支架治疗老年症状性大脑中动脉狭窄患者的安全性和有效性

目的评估Enterprise支架治疗老年症状性大脑中动脉狭窄患者的安全性及有效性。方法回顾性分析2013年1月~2015年12月在火箭军总医院神经介入医学科接受Enterprise支架治疗的症状性大脑中动脉重度狭窄,且年龄≥60岁的患者55例,其中男性31例,女性24例,年龄60~81(66.4±8.0)岁。术前及术后给予双联抗血小板聚集药物及强化调脂治疗,采取多模态影像指导下的支架成形术,术后6个月行全脑数字减影血管造影(DSA)明确支架再狭窄情况,观察围术期并发症发生率、支架内再狭窄发生率及靶血管供血区脑卒中复发率。结果手术技术成功率100.0%,术前及术后即刻残留狭窄率(86.6±10.0)%、(29.9±13.2)%。围术期发生1例(1.8%)穿支脑梗死事件,术后随访期有1例脑出血,2例支架内急性闭塞,1例短暂性脑缺血发作事件,术侧大脑中动脉供血区缺血性脑卒中发生率为3.6%。有36例(65.5%)患者接受了DSA复查,血管狭窄率为(34.3±22.8)%,8例(22.2%)患者出现支架内再狭窄。结论 Enterprise支架治疗老年症状性大脑中动脉重度狭窄患者是安全的,且能有效预防供血区脑卒中复发。     

经桡动脉途径血管内支架成形术治疗老年症状性椎动脉狭窄的临床研究

目的探讨经桡动脉途径血管内支架成形术治疗老年症状性椎动脉狭窄的有效性和安全性。方法选择老年症状性椎动脉狭窄患者45例,行经桡动脉途径椎动脉支架成形术,观察其手术成功率、围术期并发症及临床疗效。结果 45例患者中,椎动脉开口置入球扩式支架43枚,椎动脉颅内段置入自膨式支架2枚,术后即刻造影,残余狭窄<20%,技术成功率达100%。围术期未发生动脉夹层、支架内血栓形成、颅内出血等并发症。与术前比较,术后临床症状明显好转,术后2～7d血流动力学明显改善(P<0.01)。总有效率93.3%。术后随访3个月～4年,平均(24±8)个月,支架内再狭窄12例(26.7%),无与责任血管相关的短暂性脑缺血发作及后循环脑梗死发生。结论经桡动脉途径血管内支架成形术治疗老年症状性椎动脉狭窄临床疗效好,并发症少,是一种安全有效的治疗方法。     

中西药结合血管内支架成形术治疗症状性大脑中动脉狭窄

目的 探讨中西药结合血管内支架成形术治疗症状性大脑中动脉狭窄的应用.方法 在中西药结合治疗基础上,对临床诊断分水岭脑梗死15例和短暂性脑缺血发作10例患者行全脑血管造影术,发现大脑中动脉M1段存在不同程度狭窄,对狭窄段大脑中动脉行颅内支架成形术.结果 25例大脑中动脉支架成形术均获得成功.大脑中动脉M1段平均直径狭窄程度从90.8 %降至10%～20%(P＜0.01).术后随访6个月,所有患者均无脑缺血事件发生.结论 采用中西药结合血管内支架成形术治疗症状性大脑中动脉狭窄可行.     

Benign intracranial hypertension.

Ninety percent of these 120 patients with BIH were women and were obese. Headache was present in almost all patients and visual symptoms occurred in 35%. There was no neurologic abnormality other than visual loss in these patients followed up to 10 years. Twenty-five percent spontaneously remitted after the initial LP and the others required repeated LP, steroids, or surgical procedures. Thirteen of 15 patients who did not remit spontaneously or respond to repeated LP improved dramatically in 3 to 4 days on prednisone or dexamethasone. Complications of BIH include recurrence of the syndrome, visual impairment and development of the empty sells syndrome. Recurrence rate was 10% and relapses always occurred in the first 12 months. Visual acuity impairment or inferior nasal quadrant field defect occurred in 2% of patients. In only two patients was there a sudden decrease in visual acuity which did not improve with any therapy. There was no way to predict subsequent visual impairment.     

Treatment of intracranial aneurysms

The management of intracranial aneurysms (IAs) remarkably improved due to the development of diagnostic and surgical procedures. Subarachnoid hemorrhage (SAH) from IA rupture constitutes a devastating event, whose prognosis remains unsatisfactory. At present, several researchs are targeted to individuate subjects harboring unruptured IAs and those presenting a higher risk for rupture. Numerous risk factors for the rupture of lAs have been individuated. The prevalence of intracranial saccular aneurysms in the general population is estimated from 0.2% to 6.8%, with an incidence of SAH at 10/100,000/year. The most relevant morbidity and mortality rates after SAH are related to rebleeding and vasospasm. The primary therapeutic target consists in prevention of rebleeding. At present, therapeutic opportunities for intracranial aneurysms are microsurgery and endovascular treatment.     

颅内动脉瘤壁细胞凋亡观察

目的探讨囊性动脉瘤破裂的机制。方法采用原位DNA末端标记法（TUNEL）观察28个颅内囊性动脉瘤瘤壁细胞凋亡和坏死情况。结果TUNEL标记阳性的细胞散在于动脉瘤壁,动脉瘤顶部存在成片的TUNEL阳性染色（考虑为瘤壁坏死灶）,在瘤顶部破裂口周围可见阳性细胞聚集。动脉瘤破裂组凋亡细胞的阳性率（平均39％）与未破裂动脉瘤组（平均21％）相比,P〈0.01。结论动脉瘤壁的肌纤维细胞发生凋亡甚至坏死是导致瘤壁脆弱并自发破裂的机制之一。     

Warfarin and intracranial haemorrhage

SUMMARY: Spontaneous intracerebral haemorrhage is one of the most feared complications of long-term anticoagulation. Warfarin therapy not only increases the likelihood of suffering an intracranial haemorrhage, but also increases the mortality associated with it. This review aims to examine the incidence, pathogenesis, and outcome following a warfarin associated intracranial haemorrhage. It also evaluates the available evidence regarding optimal management of these patients, including timing and strategies for reversal of the coagulopathy, the role of neurocritical care and surgery, and indications for re-anticoagulation once the acute phase has past. The specific management of patients with prosthetic heart valves is also discussed. A summary of current societal guidelines is also included, as are some key practice points.     

Management of intracranial aneurysms

Intracranial aneurysms are lesions commonly encountered by neurosurgeons, usually as a result of subarachnoid hemorrhage. The preferred treatment of these aneurysms is either surgical clipping or endovascular coiling, both of which eliminate the aneurysm from the normal circulation to prevent aneurysmal enlargement or additional hemorrhage. Despite advances over the last several decades in the understanding of intracranial aneurysms, morbidity from treatment of these lesions remains significant. This review will discuss the epidemiology, anatomy and pathophysiology, clinical and radiographic diagnosis, various treatment options, and potential complications from aneurysm treatment.     

Hyponatremia in intracranial disorders

Hyponatremia is a common electrolyte disturbance following intracranial disorders. Hyponatremia is of clinical significance as a rapidly decreasing serum sodium concentration as well as rapid correction of chronic hyponatremia may lead to neurological symptoms. Especially two syndromes leading to hyponatremia in intracranial disorders need to be distinguished, as they resemble each other in many, but not all ways. These are the syndrome of inappropriate ADH secretion (SIADH) and the cerebral salt wasting syndrome (CSW). The syndrome of inappropriate ADH secretion is characterized by water retention, caused by inappropriate release of ADH, leading to dilutional hyponatremia. The cerebral salt wasting syndrome on the other hand, represents primary natriuresis, leading to hypovolemia and sodium deficit. SIADH should be treated by fluid restriction, whereas the treatment of CSW consists of sodium and water administration. However, in the literature there is abundant evidence that hyponatremia in intracranial diseases is mostly caused by CSW. Therefore, treatment with fluid and salt supplementation seems indicated in patients with intracranial disorders who develop hyponatremia and natriuresis.