颈动脉支架置入术治疗颈动脉狭窄32例临床分析

目的 探讨颈动脉狭窄支架置入术(CAS)的经验及治疗颈动脉狭窄的临床效果,安全性及并发症.方法 32例患者全部行全脑血管造影显示颈动脉狭窄70％ ～ 93％,术中应用远端保护装置,其中10例预扩张狭窄部位,32例均释放颈动脉自膨式支架.结果 所有支架释放定位准确,残余狭窄＜30％.围手术期l例斑块脱落,成功回收,10例出现心动过缓或低血压发生,1例术后1年再狭窄,1例穿刺部位出现皮下血肿.结论 CAS治疗颈动脉狭窄是一种安全有效的方法之一.     

冠状动脉搭桥术前超声检测颈动脉狭窄的临床意义

目的 评价血管超声技术应用于冠状动脉搭桥术(CABG)前的临床价值及意义.方法 随机抽取拟行CABG的住院患者共104例,年龄(68.9±6.09)岁,于CABG前1周之内进行颈动脉超声检查,判断颈动脉狭窄程度,对颈动脉超声提示重度狭窄和/或闭塞的患者进行颈动脉造影检查并依据检查结果进行干预治疗.结果 颈动脉重度狭窄和/或闭塞患者超声和造影检查结果具有很好的相关性(相关系数r=0.92,P<0.001).对颈动脉超声和造影均显示重度狭窄和/或闭塞的10例患者在CABG前进行了颈动脉内膜剥脱术(CEA)或颈动脉支架置入术(CAS),这些患者在CABG围术期无1例脑血管并发症发生.结论 应用血管超声技术可准确检测颈动脉狭窄程度,其结果与颈动脉造影具有很好的相关性,依据颈动脉超声及造影结果,对严重狭窄和/或闭塞的颈动脉进行介入治疗或手术治疗可明显降低CABG围术期脑卒中的发生率.     

脑保护下颈动脉支架成形术89例围术期护理

对89例高危颈动脉狭窄患者实行脑保护下颈动脉支架成形术(CAS)治疗,术前进行严格实验室检查、正规药物治疗和精心围术期护理.结果手术成功率为98.9%,死亡2例,梗死2例,出现颈动脉窦反射27例,穿刺部位血肿6例,经再次加压包扎后血肿逐渐消失.认为CAS是一种安全、有效的治疗手段,做好围术期的护理可有效降低手术风险.     

颈动脉狭窄患者颈动脉支架植入术血流量评估中CTA联合DCE的应用价值探讨

目的 探究分析颈动脉狭窄患者颈动脉支架植入术血流量评估中CTA联合DCE的应用价值.方法 选取我院收治的颈动脉狭窄行CAS术患者50例为研究对象.为术前行CTA联合DCE检查,术后2周复查DCE,对比颈动脉狭窄患者颈动脉支架植入术完成后患者患者脑血流动力学改变情况,主要从患者术前与术后的CBF情况、CBV情况、MTT情况进行考量.结果 行CAS术50例患者中,狭窄动脉数量为55条,其中1条出现了闭塞的情况,其中53例的狭窄部位在患者的颈内动脉起始部,其中发现患者出现颈部总动脉狭窄1例,单侧边出现动脉狭窄患者45例,双侧边出现动脉狭窄患者5例.经以DSA为金标准对比,对比CTA与DCE的两个检查结果发现,两类检测方法并未出现差别.患者接受CAS术治疗之前,其双侧的脑血流动力学数值有明显的差别(P＜0.05),但是在对比中发现患者出现狭窄情况的颈动脉血管CBF数值相对于无狭窄情况的颈动脉血管CBF数值较小,而MTT时间相对较长(P＜0.05),但是健侧与患侧的CBV无明显的差异(P＞0.05);治疗完成后,患者患侧情况恢复正常.结论 通过将CTA联合DCE进行联合应用,能有效的观察颈动脉狭窄患者颈动脉支架植入术前后的脑血流动力学变化情况,从而对于患者颈动脉支架植入术的效果进行有效评价,并对于患者术后的治疗方案与随访计划制定有着一定的指导作用.     

34例颈动脉狭窄支架置入术临床分析

【目的】总结分析颈动脉狭窄支架置入术中各种并发症发生的原因与防治对策。【方法】对34例颈动脉狭窄〉70％的患者,予以支架置入治疗,并在术中术后严密观察其并发症的发生,同时在支架置入时使用脑保护器。【结果】34例患者共置入35枚支架。手术成功率100％,支架形态良好。有2例术中出现一过性意识障碍,支架置入术后患者动静脉循环时间为3．23s．说明术后患者脑动、静脉循环时间大为改善,24例临床症状完全消失。8例肢体轻度活动受限,2例吐词不清较前好转。【结论】血管内支架成型术（CAS）对于颈动脉狭窄的治疗是有效的。从治疗即刻效果看,能使狭窄管腔重新塑型扩张,改善了血流状态。术后观察2～20个月无一例再狭窄发生。与颈动脉内膜剥离术比,它有创伤小、痛苦轻、成功率高、并发症少等优点,是治疗颈动脉狭窄最有前景的好方法。但远期疗效还值得进一步追踪随访。     

双侧颈动脉重度狭窄患者介入干预后再发脑卒中的短中期随访

目的评价介入颈动脉血管内支架置入术和内科药物治疗双侧重度颈动脉狭窄患者的效果,观察干预后再发脑卒中的中短期随访结果。方法21例双侧重度颈动脉狭窄患者,按随机数字表分成两组:A组8例患者接受颈动脉血管内支架置入术治疗,B组13例患者接受内科药物治疗;1年半后分别随访临床和超声波检查。结果A组8例手术患者支架放置成功,术前颈动脉狭窄程度为70%～98%,术后狭窄程度小于10%,除1例偶发1次短暂性脑缺血发作(TIA)外,其他患者未出现脑血管病发作;B组9例(9/13)患者再次发生脑卒中(其中4例患者出现TIA发作,2例死亡),另4例(4/13)患者病情无变化,超声波检查发现7例(7/11)患者颈动脉内中膜增厚、动脉粥样斑块增多增大,管腔进一步狭窄。结论颈动脉狭窄血管内支架置入术中短期疗效优于内科药物治疗。     

颈动脉狭窄血管内支架置入10例护理体会

目的:探讨颈动脉支架置入术治疗颈动脉狭窄的护理方法.方法:对10例颈动脉狭窄患者采用经股动脉穿刺插管行全脑血管造影,显示有血管狭窄行颈动脉支架置入术.结果:本组患者均成功置入支架,患者临床症状改善,未发生严重的并发症.结论:加强手术前后的护理,严密观察病情及预防并发症,患者主动配合治疗是手术成功的关键.     

自膨式支架成形术治疗颈动脉狭窄的临床价值

[目的]探讨血管内支架成形术治疗颈动脉狭窄的临床价值.[方法]18例症状表现为反复短暂性脑缺血发作或脑梗死的颈动脉狭窄患者,在用球囊扩张狭窄动脉后安装自膨式血管内支架,其中12例在狭窄动脉远端放置了脑保护伞装置.[结果]支架放置均准确,手术后15例患者颈动脉狭窄部位恢复正常管径,2例狭窄程度减少90%,1例减少70%.1例术中发生脑梗死,17例无并发症发生.随访6～18个月 ,均未再有短暂性脑缺血发作或脑梗死发生,DSA复查9例患者均无再狭窄（6～12个月）.[结论]血管内支架成形术是治疗颈动脉狭窄安全、简便而有效的方法,为了预防出现脑缺血并发症,手术中使用脑保护装置是十分必要的.     

双侧颈动脉狭窄行支架扩张术并发症的护理

[目的]总结双侧颈动脉狭窄行支架置入术病人的护理经验。[方法]选择我科2007年11月施行的颈动脉球囊扩张支架置入术病人1例,采用经股动脉穿刺插管行全脑血管造影显示有血管狭窄,行颈动脉支架置入术。[结果]成功置入支架后临床症状改善,术中、术后均出现并发症,经过积极有效的处理,病人康复出院。[结论]加强手术前后的护理,严密观察病情,积极治疗和处理并发症,是手术成功的关键。     

颈动脉硬化狭窄支架成形常见并发症及防治

目的回顾性分析颈动脉支架成形治疗缺血性脑血管疾病围手术期常见并发症的原因及其处理。方法52例61处颈动脉狭窄行CAS治疗，成功植入40枚Wallstent支架，20枚“Z”型支架，手术成功率达98％。结果所有患者术后随访1个月，明确诊断过度灌注综合征1例，6例患者出现程度不等的头晕、头痛；12例出现颈动脉窦反应；1例术后脑MRI新发脑梗死，1例双侧重度狭窄的患者术中出现短暂性脑缺血发作；术中脑血管痉挛12例；发现穿刺局部血肿6例（假性动脉瘤2例），动静脉瘘1例。结论术前充分准备、术中规范化操作、术后积极正规治疗可明显降低CAS围手术期并发症、改善预后。     

支架置入及经皮血管成形治疗颅外颈动脉狭窄

背景：颈动脉支架置入是一种微创、安全、简便的介入治疗方法,对于身体基础状况差不能耐受开放手术的颈动脉狭窄患者尤其有意义。 目的：探讨支架置入联合经皮血管成形治疗颅外颈动脉狭窄的临床效果。 方法：纳入颅外颈动脉狭窄患者29例,其中男19例,女10例,年龄45-78岁,进行支架置入及经皮血管成形治疗,治疗前及治疗后24 h进行美国国立卫生研究院卒中量表量表、神经功能评分及CT检查;随访3-12个月,复查凝血指标及颈动脉B超。 结果与结论：1例患者为右侧颈总动脉分叉部完全闭塞,经治疗仅颈外动脉管径恢复50.0%,其余患者均经血管造影证实完全恢复至正常水平,治疗成功率为97%。29例患者治疗后24 h的颈动脉病变血管长度、美国国立卫生研究院卒中量表量表、神经功能评分均较治疗前明显改善（P＜0.01,P＜0.05）。随访3-12个月,所有患者均未出现脑梗死和短暂脑缺血发作,颈动脉狭窄明显改善,6个月复查时患者出现再狭窄,再狭窄率为3%。表明经皮血管成形联合生物材料支架置入治疗颅外颈动脉狭窄可以获得良好的临床效果。     

颈动脉狭窄的DSA诊断与血管内介入治疗

目的探讨颈动脉狭窄的血管内介入诊疗价值.方法回顾性分析142例颈动脉狭窄患者的血管内介入诊疗资料.结果 DSA检查均能获得明确的诊断.颈动脉造影显示全部患者颈动脉均有不同程度的狭窄,其中面积狭窄百分比≤50%者26例,狭窄程度＞50%而≤70%者66例,狭窄程度＞70%者50例.38例颈动脉狭窄患者拟行血管内支架者,37例成功地置入了血管内支架,即刻DSA显示狭窄程度由术前的78.7% (64%～100%)下降到约32.4% (0～58%).结论血管内介入技术在颈动脉狭窄的诊断与治疗中具有重要价值.     

支架植入术在颅外段症状性颈动脉狭窄中的应用

目的:观察支架植入术在颅外段症状性颈动脉狭窄中的临床疗效。方法:回顾性分析行支架植入术的颅外段症状性颈动脉狭窄患者60例的临床资料,评价手术的临床疗效。结果:颈动脉支架60枚全部准确释放,颈动脉狭窄均成功解除;术后残余狭窄率<20%;临床症状消失或好转55例,症状缓解不明显5例;发生一过性心率、血压下降11例,发生高灌注综合症1例,发生TIA1例,经积极治疗均好转;术后30d随访未再发生脑血管事件。结论:颅外段症状性颈动脉狭窄的患者行支架植入术治疗安全、有效。     

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.     

老年颅外段颈动脉狭窄的血管内治疗及围手术期护理

目的探讨老年颅外段颈动脉狭窄患者经皮血管内支架置入血管成形治疗及围手术期护理等相关问题。方法21例老年颅外段颈动脉狭窄患者经全脑数字减影血管造影(DSA)检查诊断后,均采用经股动脉入路应用自膨式支架行经皮血管内支架置入血管内成形术治疗。结果21例(次)支架置放均获成功。DSA显示狭窄段的颈动脉直径明显扩大。仅1例出现部分运动性失语。随访2~24个月,全部患者均未再发生脑缺血,其中2例行DSA复查,6例行多普勒超声复查,均无再狭窄发生。结论经皮血管内支架置入血管成形术治疗老年颅外段颈动脉狭窄安全性高,效果可靠,围手术期护理是手术成功的保障。     

Diagnosis and invasive management of carotid atherosclerotic stenosis

Carotid atherosclerotic stenosis is a known risk factor for ischemic stroke. Methods for detecting stenosis and revascularization abound. The objective of this review was to summarize the evidence for diagnosing carotid artery stenosis and treating symptomatic or asymptomatic stenosis with endarterectomy or stenting. An Ovid MEDLINE search identified relevant original research published between 1990 and 2006. With acceptable surgical risk and patient life expectancy, carotid endarterectomy is clearly indicated for symptomatic stenosis of more than 70%. Carotid endarterectomy is also recommended for symptomatic stenosis of more than 50%, but the health impact is less compelling. The US Food and Drug Administration has approved several stents for a subset of patients with carotid stenosis. Randomized comparisons of endarterectomy vs stenting have been performed in average- and high-risk patients with asymptomatic and symptomatic carotid artery stenosis with mixed results.     

A refined angioplasty and stenting technique may offer an alternative to carotid endarterectomy

Strokes are the third leading cause of death in the United States. Carotid artery occlusive disease accounts for about 20% to 30% of all strokes. Carotid endarterectomy has been the traditional standard treatment for patients with significant carotid artery disease. However, surgical therapy is associated with significant complications. Carotid angioplasty and stenting offers an attractive alternative to surgery. There have been significant advances in this field including the use of embolic protection devices. In this article, we review the current literature addressing the role of endovascular interventions in the management of patients with significant carotid stenosis.     

症状性颈动脉狭窄的血管内支架治疗

目的探讨血管内支架置放术治疗症状性颈动脉狭窄的临床效果。方法对35例颈动脉狭窄>70%的患者行血管内自膨式支架置放术,术中选用保护装置27例,行球囊预扩22例,行后扩5例。结果全部患者操作顺利,共置放支架42枚,影像学评价残余狭窄<20%。临床治愈29例,好转6例。随访1～36个月,症状无复发,无再狭窄。结论血管内支架置放术是治疗症状性颈动脉狭窄的一种有效方法,术后再狭窄有待于长期随访。     

Headache in carotid artery stenting and angiography

Introduction.— Carotid angioplasty headache and diagnostic criteria are based on scarce data and small series. Here, we aimed to determine presence, frequency, and characteristics of headache after carotid artery stenting and angiography headache and speculate on possible mechanisms of head and neck pain emerging during or after the carotid artery stenting procedure. Patients and method.— The total of 64 patients who were admitted to our Neuroradiology Division of Radiology Department for primary percutaneous transluminal carotid interna stenting were included in the study. They had symptomatic or asymptomatic carotid artery disease with stenosis more than 70%. All patients were questioned by a neurologist regarding the presence, side, location, quality, severity, duration, and timing of headache after both angiography and stenting procedures. Results.— Frequency of headache after carotid interna stenting was 39.1%, it commonly arose in a short period after the procedure and relieved in 10 minutes. This type of headache was mild, ipsilateral, frontotemporal in location, pressing in nature, and arose frequently within 10 minutes after the procedure, whereas angiography headache had a frequency of 21.9% and it was ipsilateral, mild, burning‐like headache. Angiography headache also relieved within 10 minutes. Both types of headache were related to severe stenosis. Discussion.— Our study clearly demonstrates that headache is seen after carotid artery stenting (39.1%) and angiography (21.9%). Although both types of headache have similar characteristics, they differ in that it is mostly pressing in the group of carotid artery stenting and burning in angiography group.     

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.