血管内支架成形术治疗颈动脉狭窄的疗效分析

临床上经常遇到反复出现同侧脑梗死的患者，药物控制效果欠佳。近年来随着颅内支架治疗脑血管狭窄技术的日益成熟，可明确狭窄部位、程度、形状，并成功实施内支架成形术，因而对脑梗死反复发作患者起到预防作用。本文报道我院采用血管内支架成形术治疗颈动脉狭窄20例疗效分析。     

DSA三维重建成像在颈动脉狭窄诊断及内支架成形术中的初步应用

目的 总结血管造影三维重建成像(3D-Angio)在颈动脉狭窄诊断及支架成形术中的应用。方法 23例经常规血管造影证实有颈动脉狭窄患者，行3D-Angio检查并对其结果进行对比分析。其中16例患者分别在行支架成形术前后作常规血管造影(2D-Angio)和3D-Angio检查，分析其治疗前后血管的改善情况。结果 3D-Angio可以从不同角度观察血管狭窄段的轮廓改变，准确地判断狭窄程度和范围；还可了解管腔内情况，显示管腔变小，凸凹不平和突向腔内的斑块。内支架成形术后，管腔轮廓恢复正常，腔内凸凹不平可变光整，突向腔内的斑块消失。结论 3D-Angio对诊断颈动脉狭窄程度、了解狭窄段管腔内改变、评价支架成形术的结果可提供帮助。     

颅外颈动脉狭窄支架成型术

目的　探讨颈动脉颅外段狭窄支架成型术的适应证 ,手术方法及并发症的防治。方法　选择有症状的颈动脉狭窄≥ 5 0 %的患者 ,无症状的颈动脉狭窄≥ 70 %的患者 ,使用自膨胀式支架。结果　 4 0例患者 ,植入 4 8枚支架 ,术中及术后无并发症出现 ,即刻血管造影显示满意 ;术后随访颈部X线及超声波检查 ,支架形态好 ,位置无移位 ,血流通畅 ,无再狭窄。结论　血管内支架成形术治疗颈动脉颅外段狭窄安全、有效。防止血栓脱落及再狭窄需进一步研究。     

血管内支架成形术治疗外科高危的颈动脉狭窄

目的 探讨外科高危的颈动脉狭窄作血管内支架成形术的可行性及安全性。方法 7例外科高危的颈动脉狭窄患者接受了血管内支架成形术治疗。结果 支架定位准确，4例患者狭窄完全消失，3例患者狭窄程度减少90％以上，临床症状改善明显，无手术并发症，术后随访3～23个月，均无短暂性脑缺血发作或脑梗死发生。结论 血管内支架成形术是治疗外科高危的复杂型颅外颈动脉狭窄的安全有效的方法，长期疗效有待进一步观察。     

高危颈动脉狭窄患者血管内支架成形术的观察与护理

目的　总结高危颈动脉狭窄患者血管内支架成形术的观察与护理经验。方法　对 2 6例血管内支架成形术治疗高危颈动脉狭窄患者术前予心理护理、生活护理、控制血压 ,术后予严密观察生命体征、神经系统功能、严格抗凝及穿刺部位的护理。结果　无一例护理并发症发生。所有患者均成功植入支架 ,术前、术后平均狭窄程度分别为 (82 .3± 5 .1) %、(14 .0± 3.1) %。 1例出现同侧颞叶梗死 ,但恢复良好。其余均无手术并发症。结论　血管内支架成形术治疗颈动脉狭窄安全、有效 ,适合颈动脉内膜切除术高危患者 ,但由于疾病特点和此类新技术的应用 ,周密、细致的观察与护理十分重要。     

血管内支架成形术治疗颈动脉狭窄45例分析

目的探讨血管内支架成形术治疗颈动脉狭窄的疗效和经验。方法对45例颈动脉狭窄患者行血管内支架成形术,术后行全脑血管造影及颈动脉彩超检查,进行影像学随访。结果狭窄血管均成功扩张,术前、术后狭窄段血管管腔分别为(2.84±1.18)mm和(5.86±0.65)mm,术后残余狭窄程度均<20%。临床随访无TIA或脑缺血发作,无1例发生再狭窄,3个月后颈部血管彩色超声检查,狭窄段管腔内径为(5.84±0.33)mm,与术后即刻狭窄段管腔内径(5.86±0.65)mm比较无统计学差异(P>0.05)。结论血管内支架成形术治疗颈动脉狭窄是安全、有效的。     

血管内支架成型术治疗颈动脉狭窄21例

目的探讨血管内支架成型术治疗颈动脉狭窄的临床效果和安全性。方法对21例颈动脉狭窄患者,先行血管造影,然后根据血管狭窄情况,选择合适自膨式支架跨过狭窄部位,将支架送至预想的位置释放,覆盖狭窄部位。结果治疗狭窄动脉21支,狭窄程度均明显改善,狭窄程度由原来的(78.94±12.8)%下降至(3.19±3.04)%,无死亡病例,术后患者症状均明显改善,围术期无并发症。随访1~12个月,颈动脉超声检查治疗血管无再狭窄。结论只要适应证选择正确,围术期处理得当,血管内支架成型术治疗颈动脉狭窄,不仅临床效果好,而且安全性高。     

过滤伞保护下的颈动脉狭窄支架成形术

目的 分析过滤伞保护下颈动脉狭窄支架成形术的安全及有效性。方法 25例症状性颈动脉狭窄支架成形术中采用过滤伞装置，首先将过滤伞通过狭窄部位并释放，然后进行狭窄的血管内支架成形术，观察手术期脑栓塞发生的情况，大体观察回收的过滤伞。结果 25例过滤伞放置及支架成形术均成功实施，回收的过滤伞中15个发现组织碎片，无手术死亡及症状性脑血栓栓塞并发症，临床短期随访无脑缺血事件发生。结论 过滤伞的保护作用能提高颈动脉狭窄支架成形术的安全性。     

血管内支架成形术治疗颈动脉狭窄

目的：总结血管内支架治疗颈动脉狭窄的临床体会，探讨该技术的适应证、并发症防治及初步疗效。方法：2000年10月至2001年9月共收治颈动脉狭窄52例，44例表现为反复的短暂脑缺血性发作或脑梗死。7F长鞘置入颈总动脉，预扩张球囊通过狭窄部位行预扩张（19例），自膨胀支架在导丝支撑下通过狭窄部位，回撤外鞘将支架释放，对29例患者应用不可脱卸球囊进行支架内再扩张。结果：支架定位准确，34例患者狭窄完全消失，16例狭窄程度减少90％以上，2例减少70％，1例术中发生脑梗死，无其他手术并发症发生。临床随访3-13个月（平均7.3个月），均未再有短暂性脑缺血发作或脑梗死。颈动脉超声随访45例，DSA随访19例患者颈动脉均无再狭窄发生（6-12个月）。结论：血管内支架成形术是治疗颈动脉狭窄安全而有效的方法，长期疗效有待于进一步观察。     

支架植入后再狭窄防治的研究进展

颈动脉、椎动脉狭窄是临床常见病变，约95％患者是由动脉粥样硬化引起。颈动脉狭窄的外科治疗方法包括传统的动脉粥样硬化斑块切除术和微创的血管内成形术，支架成形术能否替代传统手术将取决于其安全性及支架植入后的再狭窄。大规模的颈动脉狭窄支架植入临床结果示，6个月及12个月的再狭窄率分别是1．99％和3．46％。本文综合介绍近年来在血管内支架植入术后再狭窄机制及治疗方面的研究进展。     

Clinical results of carotid artery stenting with a nitinol self-expanding stent (SMART stent)

Our objective was to assess the technical feasibility and the clinical results of internal carotid artery (ICA) stenting using a nitinol self-expanding stent (SMART stent). In 13 patients 13 high-grade stenoses of the internal carotid artery were treated via an implantation of a SMART stent. In all cases a predilation of the stenosis and a postdilation within the stent were performed. Follow-up examinations were carried out in all patients after a period of 6 months. In each case the implantation of the stent was performed without technical complications. In 12 of 13 cases the stent was placed in the patients' internal carotid artery, in 1 case from the internal to the common carotid artery (CCA). The average degree of stenosis of 78% (70-95%) was reduced to an average of 2.8% (0-21%). The 6-month follow-up angiography showed an average degree of restenosis of 11.8% (0-29%) in 8 of 13 patients. Duplex sonography in the remaining 5 patients demonstrated patent stents. One patient showed brief neurological symptoms during the intervention. No further complications occurred during follow-up time. Treatment of internal carotid artery stenosis with the SMART stent seems technically feasible, safe, and promises long-term patency.     

颈动脉狭窄的支架治疗

目的:分析探讨颈动脉支架成形术治疗颈动脉狭窄的安全性。方法:本组34例患者,在球囊扩张及支架释放过程中,全部使用保护伞,并对颈动脉狭窄程度大于70%的16例患者进行预扩张,扩张后根据狭窄长度置入自膨式支架,未扩张的18例患者直接置入自膨式支架,其中有3例未扩张的患者,支架释放后未完全膨胀,但狭窄的直径超过了80%,血流通畅,未进行后扩张。结果:支架置入成功率100%,无1例患者出现脑出血、脑梗塞等严重并发症,支架置入后,支架膨胀良好,血流通畅,患者临床症状得到明显改善。结论:颈动脉支架置入治疗颈动脉狭窄是一种新的治疗方法,亦能代替经典颈动脉内膜剥离术,并对颈动脉狭窄引起的卒中的预防和治疗发挥了重要作用。     

血管内支架治疗颈内动脉狭窄27例体会

目的总结血管内支架治疗颈内动脉狭窄的疗效及其体会。方法选择我院2004年12月至2006年3月经DSA证实颈内动脉狭窄患者27例，全部经全脑血管造影及颈部超声检查后，行经皮腔内血管成形和支架植入术治疗。结果术后超声及DSA证实，手术成功率100％，治疗后残余狭窄率均低于30％，27例患者中与操作相关的并发症包括2例（7．4％）出现可逆性小卒中；3例（11．1％）出现术中球囊扩张时对侧肢体局灶性癫痫发作；5例（18．5％）血管痉挛；6例（22．2％）出现低血压和心动过缓。18例随访6个月～18个月，无1例再次发生脑梗死。结论血管内支架成形术是一种治疗颈内动脉狭窄安全有效的方法，提高术者操作技巧及加强围手术期监护可以大大降低手术并发症和病死率。     

血管内支架在治疗颈内动脉高度狭窄疾病中的应用

目的 探讨血管内支架在颈内动脉高度狭窄病例中的应用。方法 １９９８～１９９９年,对８例颈内动脉高度狭窄病例进行了经皮血管内成形术（ＰＴＡ）与支架治疗,采用了３种支架。在充分准备后,根据病变的不同,采取不同的支架与操作,使手术完全成功。结果所有病例术后影像学复查表明是成功的,临床症状消失或好转。８例一过性缺血（ＴＩＡ）及头痛、头晕完全消失;８例肢体无力者６例恢复,２例好转;４例一过性黑朦症状消失;     

Morphological changes of ulcerative plaque in patients received carotid angioplasty and stenting (CAS)

BACKGROUND: Carotid ulceration plaque is a strong risk factor for stroke and systemic vascular events. The purpose of this study was to assess immediate and follow-up ulcer morphology after carotid angioplasty and stenting (CAS). METHODS AND RESULTS: A total of 124 patients were included in the study. Ulcerative plaques were identified in 92 arteries from 81 patients (21% were asymptomatic and 79% symptomatic). The ulcer disappeared immediately after stenting in 36 (39%) of 92 arteries in 50 patients. Patients with initial mild degree of stenosis (50-69% stenosis) prior to stent, Type-3 and Type-4 ulcers were more prone to have residual ulcers immediate after stenting procedure. Ulcers located distal and proximal to the site of maximal stenosis, and ulcers extending outside of the imaginary line connecting the distal and proximal normal borders of the carotid artery were also more likely to have residual ulcers (P<0.001). Follow-up angiograms (mean time after CAS=10.1 months, range=3-28 months) performed in 32 arteries (29 patients) revealed that residual ulceration disappeared in 17 lesions (53%) and became smaller in 15 lesions (47%). During follow-up, ipsilateral neurological symptoms were not evident in any of the 29 patients (mean time after CAS=20.1 months, range=9-41 months). CONCLUSIONS: Ulceration morphology, and stenosis severity prior to stent procedure had an impact on ulcer coverage after CAS. Our findings suggest that residual ulcers disappear or improve over time and that with appropriate medication, will not lead to embolic strokes.     

Outcomes of carotid angioplasty and stenting for radiation-associated stenosis

BACKGROUND AND PURPOSE: In light of their high surgical risk, carotid angioplasty and stent placement may be preferred in patients with radiation-associated carotid stenosis. The purpose of this study was to determine the procedural complication rate, patency, and clinical outcomes after carotid angioplasty and stent placement in this small group of high-risk patients. METHODS: Sixteen patients (mean age, 65 years; 5 women and 11 men) who received radiation therapy for head and/or neck malignancy subsequently developed carotid stenosis (mean, 84%; range, 70%-99%) in a total of 19 carotid arteries, which were treated with angioplasty and stent placement. The patients were followed for a mean time of 28 months (range, 5-78 months) with periodic Doppler studies, angiography, CT angiography, or clinically. RESULTS: In the total 19 stented carotid arteries, 23 procedures were performed (22 stent placement procedures and one repeat angioplasty). The procedural stroke rate was 1/23 (4%). The procedural transient ischemic attack rate was 0/23 (0%). There was one other observed complication: a puncture site hematoma. The 30-day postprocedure complication rate was 0/23 (0%); no neurologic symptoms were reported. Fifteen of the 19 vessels (79%) developed no new stenosis throughout the follow-up period. Two of 19 (11%) vessels had repeat angioplasty and stent placement; 1/19 (5%) had a repeat angioplasty. One restented vessel has remained patent for 50 months. Another restented vessel required a third stent placement 17 months after the second. Two of 19 (11%) vessels occluded per Doppler examination 14 and 22 months postprocedure. CONCLUSION: Angioplasty and stent placement have low rates of complications and restenosis in the treatment of radiation-associated carotid occlusive disease.     

冠脉内支架植入术后再狭窄的危险因素分析

目的：分析冠脉内支架植入术后再狭窄的危险因素,方法自1996年1月至2000年9月1025例冠脉内支架植入术后患者中,101例因胸痛复发或由于医生动员而行冠脉造影随访,记录这些患者的冠心病易患因素,对病变狭窄程度及长及用QCA测定,以支架植入节段内径≥50％为再狭窄。结果：101例患者共122处病变植入支架,造影显示支架内再狭窄52例（62处病变）。多因素逐步回归分析显示,再狭窄与血浆胆固醇,Lp(a),尿酸浓度、术前狭窄程度,术后残余狭窄呈正相关,其比数比（OR）分别为1．21、1．94、1．13、1．07和1．63,与术前参考血管直径和支架呈显著负相关,OR分别为0．24和0．31。结论：冠脉内支架植入术后再狭窄受多因素的影响,控制血脂,避免冠脉内小支架应用以 后即刻疗效满意对减低冠脉内支架植入术后再狭窄具有重要作用。     

近、远端保护装置在颈动脉重度狭窄支架治疗中的联合应用

目的总结联合应用近、远端保护装置经皮血管内支架治疗颈动脉重度狭窄的方法及经验。方法 2010年3-7月经造影确诊的颈动脉或颈内动脉颅外段重度狭窄患者5例,联合使用近端+远端保护装置,经股动脉穿刺行颈动脉支架置入手术。结果除1例操作失败未能完成外,其余4例支架置入均获成功,术中未出现并发症,治疗效果满意。随访1~3个月,未出现脑缺血表现。结论对某些特殊颈动脉狭窄病变,在颈动脉支架置入术中联合应用近、远端保护装置,可弥补单一保护装置的不足,降低术中栓塞的风险,缩短术中血流中断时间,减少危险操作步骤,可作为颈动脉狭窄个体化治疗的选择。     

颈动脉狭窄的经皮血管内支架成形治疗

目的评价经皮血管内支架成形术对颈动脉狭窄并发脑梗死病例的治疗效果。材料与方法７例颈动脉狭窄所致的缺血性脑神经功能障碍患者接受血管内支架成形治疗，术中选用Ｇｉａｎｔｕｒｃｏ－Ｒｏｕｂｉｎ球囊膨胀式金属支架。结果在７例患者的血管造影中发现：６例颈内动脉狭窄和１例颞浅动脉闭塞。在６例颈内动脉狭窄病例中，包括４例局限性狭窄，１例血管完全性闭塞，１例多节段性狭窄。本组７例中６例接受内支架成形手术，成功置入支架６枚；术后其神经功能症状得到满意恢复，在１～３０个月的随访观察中，无一例再发生脑梗死。结论经皮血管内支架成形术可解除颈动脉狭窄所致的血流循环障碍，有效地预防由此引起的缺血性脑梗死。