髂动脉闭塞内膜下再通治疗与覆膜支架的应用

目的 探讨应用内膜下再通和覆膜支架植入术治疗髂动脉硬化闭塞病变的方法和疗效.方法 5例伴有严重缺血症状的髂动脉完全闭塞病变患者,动脉闭塞长度2.5～12.0 cm.采用顺行途径(经右肱动脉穿刺3例,经对侧股动脉穿刺2例)对闭塞段血管行意向性内膜下途径再通,用直径8 mm球囊对内膜下通道扩张成形并植入镍钛合金覆膜支架,共植入覆膜支架6枚,另在1处狭窄病变植入覆膜支架1枚,1处长段闭塞病变覆膜支架远段和另1处髂动脉狭窄病变中各植入裸支架1枚.结果 内膜下再通操作全部获技术成功,无并发症出现.覆膜支架置放后血管腔内形态良好,血流通畅.临床症状消失或明显改善.患肢踝臂指数(ABI)平均值由0.40±0.32上升至0.89±0.15.近中期随访无症状复发.结论 动脉内膜下再通术联合覆膜支架植入术治疗髂动脉硬化闭塞病变安全、有效,近中期疗效良好.     

介入治疗创伤性颅内段颈内动脉假性动脉瘤的护理

目的探讨血管内治疗创伤性颅内段颈内动脉假性动脉瘤的方法及护理。方法采用GDC栓塞或注射NBCA胶灌注假性动脉瘤腔、可脱式球囊或弹簧栓子闭塞载瘤动脉及载瘤动脉内支架置入等方法治疗创伤性颅内段颈内动脉假性动脉瘤22例,围手术期进行针对性的心理护理及观察术后意识、瞳孔等生命体征、肢体感觉运动。结果除1例载瘤动脉闭塞后因严重贫血发生脑梗塞而遗留轻度神经功能缺失外,21例假性动脉瘤均取得治愈的效果。结论经血管内栓塞治疗创伤性颅内段颈内动脉假性动脉瘤操作简单、损伤小、安全、有效。     

支架在治疗颅内宽颈动脉瘤中的应用

目的分析颅内支架在治疗颅内宽颈动脉瘤中的临床疗效及应用体会。方法回顾性分析12例颅内宽颈动脉瘤患者的治疗过程,其中3例动脉瘤位于颈内动脉海绵窦段,2例位于颈内动脉眼动脉段,2例位于颈内动脉后交通段,1例位于前交通动脉,2例位于大脑中动脉分叉部,1例位于椎动脉,1例位于基底动脉;绝对宽颈（瘤颈〉4mm）动脉瘤9例,相对宽颈3例,瘤颈/瘤体均〉0.7。术中将颅内支架引至动脉瘤处并释放支架覆盖动脉瘤颈,然后行弹簧圈栓塞术。结果7例采用Neuroform自膨式支架,5例采用Leo支架,12枚支架全部成功释放。其中100%栓塞8例,95%栓塞3例,1例支架释放后动脉瘤不显影未行弹簧圈栓塞。1例术中出血经迅速填塞弹簧圈及支持对症治疗后患者治愈。本组患者无死亡。10例术后3个月随访造影,9例动脉瘤腔完全闭塞,1例达95%栓塞,载瘤动脉无狭窄。结论颅内自膨式支架辅助弹簧圈闭塞颅内宽颈动脉瘤,既可保护载瘤动脉通畅,又可提高宽颈动脉瘤栓塞的致密程度,效果较好,并且可降低穿支血管阻塞的发生率。     

脑血管腔内支架置入治疗症状性脑动脉狭窄20例

背景:关于脑血管支架置入后局部机械性血管壁损伤后发生血管内再狭窄研究中涉及的安全性、病理生理机制及临床疗效尚无确切的结论.目的:探讨脑血管腔内支架置入治疗症状性脑动脉狭窄的安全性、近期临床疗效.方法:对20例症状性脑动脉狭窄患者行脑血管腔内支架置入治疗,狭窄病变22处,位于大脑中动脉6处、颈内动脉6处、椎动脉4处、基底动脉3处,3例为椎-基底动脉狭窄;狭窄长度为3～10 mm,平均为7 mm,其中6处狭窄长度超过10 mm.行自膨式及球囊膨胀式支架置入,使用脑保护装置保护伞12例.结果与结论:20例患者22枚支架均1次放置成功,无一例发生严重并发症,置入后即刻血管造影结果显示,病变段动脉残余狭窄程度小于20%,与治疗前相比较,管腔狭窄明显改善.同时再造影的实质期可见脑组织血流灌注得到改善,临床症状全部得到改善.置入后临床随访6-24个月,20例未再有脑缺血发作,数字减影血管造影随访12～24个月7例,1例出现支架内内膜轻度增生,未引起临床症状.经颅超声多普勒随访结果示狭窄部位血流通畅,支架内未见内膜过度增生,无主要分支血管的闭塞.结果说明脑血管腔内支架置入治疗症状性颅内动脉狭窄安全,近期疗效明显,其长期疗效还需进一步随访观察.     

以反复鼻出血为主要表现的外伤性颈内动脉假性动脉瘤的诊断与治疗

目的 探讨以反复鼻出血为主要表现的外伤性颈内动脉假性动脉瘤的诊断与治疗.方法 回顾性分析外伤后反复鼻出血,并经全脑血管数字减影造影检查明确诊断为颈内动脉海绵窦段假性动脉瘤31例患者的临床资料.结果 31例均行血管内介入治疗,其中20例采用可脱性球囊栓塞直接闭塞载瘤动脉,11例采用覆膜支架置入,覆盖载瘤动脉破口.无死亡病例,均于术后2周内出院,无神经功能缺失症状,所有患者术后均未再出现鼻出血.结论 脑血管造影是确诊外伤性颈内动脉假性动脉瘤的金标准;其治疗方法首选血管内介入治疗.覆膜支架置入相比于球囊闭塞颈内动脉而言,可能是一种更有价值的血管内介入治疗方法.     

Neuroform支架结合弹簧圈治疗颅内复杂动脉瘤

目的:探讨血管内Neuroform支架置入联合弹簧圈栓塞治疗颅内复杂动脉瘤的疗效、技术要点、安全性及并发症防治.方法: 研究对象为20例颅内复杂动脉瘤患者,其中颈内动脉海绵窦段4例,眼动脉段3例,后交通动脉段7例,脉络膜前动脉起始部1例,大脑中动脉M1段1例,椎动脉颅内段4例.首先将微导管置入瘤腔,然后跨瘤颈释放支架,栓塞弹簧圈.结果: 所有病例栓塞操作均顺利完成.其中致密栓塞13例,大部分栓塞7例;术后脑梗塞1例,1个月后恢复;2例弹簧圈尾端疝入载瘤动脉,均未引起相应的临床症状.随访3～24个月,平均13个月,无再出血及血栓栓塞症状.结论: 血管内支架植入联合弹簧圈治疗颅内复杂动脉瘤安全有效.     

早期血管检查对急性脑梗死诊治的临床意义

目的通过回顾性分析静脉溶栓及血管内介入治疗急性脑梗死的临床实例,探讨早期血管检查对急性脑梗死诊治的临床意义。方法选取2015年8月至2018年8月该院收治的298例急性脑梗死患者作为观察对象,入院时间窗内给予静脉溶栓治疗,治疗过程中行头颈CTA检查,头颈CTA发现明确血管闭塞立即改用血管内介入治疗。结果 298例研究对象经头颈部CTA检查提示,138例(46.31%)存在颅内大血管狭窄/闭塞。其中颈内动脉狭窄18例;大脑中动脉M1段闭塞39例,狭窄33例;大脑中动脉M2段闭塞30例,大脑后动脉闭塞18例。160例不存在颅内大血管闭塞/狭窄事件。298例患者均行静脉溶栓治疗,治疗后症状好转212例,有效率为71.1%;86例静脉溶栓后疗效均不佳,时间窗内(6h)进行血管内介入治疗的患者46例,血管内治疗后有效人数32例,有效率为69.57%。结论急性脑梗死患者溶栓过程中,应尽早完善头颈部血管检查,明确是否存在大血管闭塞事件,以便于早期启动血管内介入治疗,保障患者预后。     

超选择动脉溶栓联合血管内支架成形术治疗合并动脉狭窄的急性脑梗死

目的:评价超选择动脉溶栓联合血管内支架成形术治疗合并动脉狭窄的急性脑梗死的临床疗效。方法:对6例合并动脉狭窄的急性脑梗死病人,其中颈内动脉闭塞3例、大脑中动脉闭塞2例、椎动脉闭塞1例。将微导管超选择送至血管闭塞部位,注入艾通立(重组组织型纤溶酶原激活剂,r-TPA)行动脉溶栓,然后对明显的残余血管狭窄,采用血管内支架成形术治疗。结果:治疗前临床神经功能缺损评分犤1犦(europeanstrokescale,ESS):53.60±13.25;治疗后7dESS评分:91.65±15.36。6例有明显的血管狭窄者全部狭窄均在75%～99%之间,术后全部血流通畅,脑血流量恢复。支架定位准确,血管残余狭窄<14%。结论:早期超选择动脉内接触性溶栓结合支架血管内成形术是治疗合并动脉狭窄的急性脑梗死患者的最有效的方法之一。     

急性颈动脉串联闭塞血管内治疗的研究进展

<正>颈动脉串联闭塞是指颅外段颈内动脉重度狭窄(90%以上)或闭塞伴随颅内大血管闭塞,其所致急性缺血性卒中早期以静脉溶栓为主,但治疗后血管再通率较低,整体疗效欠佳[1]。随着对急性缺血性卒中血管内治疗研究的不断深入,使颈动脉串联闭塞患者的血管再通率升高,可快速有效的挽救缺血半暗带脑细胞,从而改善患者预后[2]。然而,临床对于颈动脉串联闭塞的处理方法、颈动脉支架植入时机及抗血小板药物使用等方面仍存在争议。目前,颈动脉串联闭塞患者的最佳治疗方法尚     

血流动力学平衡的颈内动脉及椎-基底动脉的介入治疗

目的 探讨出现血流动力学平衡现象的颈内动脉及椎-基底动脉狭窄患者的介入治疗方案.方法 患者52例,其中行颈内动脉支架成形术介入治疗27例,未处理6例,行颈内动脉栓塞术1例;行椎动脉及基底动脉支架成形术介入治疗16例,行椎动脉栓塞术2例.结果 一次性成功植入支架43例,栓塞病变血管3例,未行介入处理6例;颈动脉支架术后闭塞3例.结论 对于病变血管发生血液动力学平衡的患者应行个体化治疗.     

Primary balloon angioplasty for chronic occlusion of intracranial internal carotid artery: A case report

Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China. Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke. Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion. Medical management is regarded as the standard treatment for this disease. With the development of endovascular treatment, some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy. We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery. Simple balloon angioplasty was performed, and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications. At 4 months follow-up, the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically. In addition, we briefly reviewed the relevant literature.     

颅内支架辅助栓塞宽颈动脉瘤初步经验

目的 探讨颅内宽颈动脉瘤新的血管内治疗技术,初步评价该技术和新栓塞材料的安全性和有效性.方法 回顾我们治疗中心近9个月内收治的11例宽颈动脉瘤病人的临床资料.对颅内Neuroform 支架辅助生物活性Matrix弹簧圈栓塞宽颈动脉瘤技术特点进行探讨,并通过对部分获得血管造影随访病人的疗效观察,评价该技术的临床应用价值.结果 联合颅内Neuroform支架和生物活性Matrix弹簧圈血管内治疗的11例宽颈动脉瘤病人中,除1例死于并发症外,其余病人均得到满意疗效,其中6例病人术后半年行数字减影血管成像(DSA)随访,未见动脉瘤复发,但仍需长期观察.结论 联合颅内支架和生物活性弹簧圈是一有效的血管内治疗颅内宽颈动脉瘤技术,颅内支架理想的大小选择和恰当的植入位置是成功治疗的重要一环,生物活性Matrix弹簧圈栓入瘤腔后可有效促进血栓和结体组织形成.     

Bilateral spontaneous internal carotid artery dissection with both early and very late recanalization: A case report

Spontaneous bilateral internal carotid artery dissection has frequently been described in the literature as a cause of stroke. In more than half of the patients with internal carotid artery dissection, recanalization occurs early after the event and is unusual later than 6 months after onset of the dissection. We describe a patient with ischemic stroke due to left internal carotid artery occlusion in the extracranial segment. The patient was treated with anticoagulants and early vessel recanalization did not occur. Ten months later, he developed contralateral internal carotid occlusion in the intracranial tract, which was followed by early complete recanalization. Anticoagulation therapy was continued and, 16 months after the initial event, the left internal carotid artery unexpectedly also reopened.     

经颅超声造影在颅内动脉狭窄闭塞性疾病的应用

目的探讨经颅超声造影在颅内动脉狭窄闭塞性疾病的应用价值。方法 59例患者超声造影前、后分别经颅超声探查颅内动脉及颈内动脉颅内段,比较造影前、后颅内动脉的显示率,总结经颅超声造影在颅内动脉狭窄闭塞性疾病的血流特点,并与MRA或DSA结果对比。结果造影增强经颅彩色多普勒(CE-TCCS)对于大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)显示率较常规经颅彩色多普勒(TCCS)明显提高,其中对于MCA(M2段)、ACA(A1、A2段)、PCA(P1、P2段)的显示率与TCCS比较,差异有统计学意义(P0.01)。21例椎-基底动脉造影前显示率为71.3%(15/21),造影后显示率为100%;CE-TCCS检出3例MCA闭塞,15例MCA狭窄,3例ACA狭窄,2例PCA狭窄;4例颈内动脉颅内段闭塞,7例颈内动脉颅内段狭窄。颈内动脉颅外段闭塞3例和狭窄8例,患者同侧颅内动脉血流灌注减少,血流速度减低。2例MCA狭窄支架置入术后,CE-TCCS显示血流通畅,速度在正常范围,所有结果均经MRA、DSA证实。结论经颅超声造影可以提高颅内动脉的显示率;有助于判断颅内动脉狭窄,也可用于颅内动脉狭窄支架置入术后疗效评价。     

颅脑损伤性颅内假性动脉瘤的临床诊治

目的探讨颅脑损伤性假设动脉瘤的诊断与治疗要点,为挽救患者生命和提高生活质量提供参考。方法回顾性分析2011年7月至2013年2月期间收治的23例颅脑损伤性假性动脉瘤患者的临床资料,并对其诊断及治疗状况进行总结和分析。结果23例患者均经全脑血管造影确诊为颅内假性动脉瘤,颅脑损伤性假性动脉瘤患者颅脑损伤后突发头痛20例,反复大量鼻衄2例,反复癫痫大发作3例,另外15例检查认定为颅内血肿8例、自发性蛛网膜下腔出血7例。假性动脉瘤位置为：6例在颈内动脉海绵窦段,5例在颈内动脉床突上段,4例在颈内动脉A2段,8例在颈内动脉床突旁段。23例患者均采用开颅切除载瘤动脉、覆膜支架、支架辅助弹簧圈栓塞、弹簧进行栓塞。术后12月随访发现痊愈19例且均无并发症。其余4例有2例偏瘫,2例死亡。结论利用全脑血管造影技术有助于确诊颅脑损伤性假性动脉瘤。开颅手术和血管内栓塞在治疗颅脑损伤性假性动脉瘤有着突出的作用,其中后者更有利于促进患者脑部功能恢复进度。     

Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): a single centre experience

The Silk stent (Balt, Montmorency, France) is a retractable device designed to achieve curative reconstruction of the parent artery associated with an intracranial aneurysm. We present our initial experience with the Silk flow-diverting stent in the management and follow-up of 25 patients presenting with intracranial aneurysms.Twenty-five patients (age range, 34-81 years; 24 female) were treated with the Silk flow-diverting device. Aneurysms ranged in size from small (5), large (10) and giant (10) and included wide-necked aneurysms, multiple, nonsaccular, and recurrent intracranial aneurysms. Nine aneurysms were treated for headache, 14 for mass effect. None presented with haemorrhage. All patients were pretreated with dual antiplatelet medications for at least 72 hours before surgery and continued taking both agents for at least three months after treatment. A total of 25 Silk stents were used. Control MR angiography and/or CT angiography was typically performed prior to discharge and at one, three, six and 12 months post treatment. A follow-up digital subtraction angiogram was performed between six and 19 months post treatment.Complete angiographic occlusion or subtotal occlusion was achieved in 15 patients in a time frame from three days to 12 months. Three deaths and one major complication were encountered during the study period. Two patients, all with cavernous giant aneurysms, experienced transient exacerbations of preexisting cranial neuropathies and headache after the Silk treatment. Both were treated with corticosteroids, and symptoms resolved completely within a month.In our experience the Silk stent has proven to be a valuable tool in the endovascular treatment of intracranial giant partially thrombosed aneurysms and aneurysms of the internal carotid artery cavernous segment presenting with mass effect. The time of complete occlusion of the aneurysms and the risk of the bleeding is currently not predictable.     

Hybrid surgery for symptomatic chronic complete occlusion of the internal carotid artery: A case report

Currently, there are antiplatelet drugs, extracranial-intracranial (EC-IC) vascular bypass, carotid endarterectomy (CEA), endovascular intervention (EI), and other revascularization procedures for symptomatic chronic internal carotid artery occlusion (CICAO). In consulting the literature, we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment. We reported the case of a 50-year-old male patient with blurred vision, headache, and weakness in the right upper limb. After the exclusion of other neurological diseases, he was diagnosed with symptomatic CICAO; the occlusion segment was long and the stump was too short. We performed a novel hybrid surgery for the patient—a carotid endarterectomy combined with internal carotid artery stenting. After 6 months of follow-up, computed tomography angiography (CTA) confirmed that the left internal carotid artery was unobstructed, and the symptoms were relieved. A brief review of the literature is presented in addition to this report.     

覆膜支架在颅颈血管病变治疗中的应用

背景：随着微导管技术的不断完善和栓塞材料的改进,血管内介入治疗已成为治疗颅颈血管病变的首选方法,主要包括可脱球囊、弹簧圈、液体栓塞剂、覆膜支架。与其他血管内栓塞治疗技术相比,覆膜支架有2个突出优点：有较高的完全闭塞率和较低的再通率。目的：介绍国内主要应用的几种覆膜支架,以及覆膜支架治疗颅颈动脉瘤和颈内动脉海绵窦瘘的临床效果。方法：以＂覆膜支架,生物相容性,动脉瘤,颈动脉海绵窦瘘＂为关键词,采用计算机检索万方数据网1998-01/2010-12相关文章。纳入覆膜支架治疗颅颈血管病变方面的文献,排除重复研究或Mata分析类文章。结果与结论：现在神经外科临床应用的覆膜支架,主要采用的是美国Abbott公司推出的Jostent覆膜支架和上海微创公司生产的Willis覆膜支架。Jostent覆膜支架优点是生物相容性和扩展性较好,其多微孔结构可减少细胞扩散,阻止血小板聚集、炎性细胞移动,从而降低了继发性血栓及血管狭窄的概率;其缺点是在颅内动脉中应用的范围比较狭窄,动脉不能过于迂曲,弯曲角度不能过于锐利,病变附近不能有不可闭塞的穿支或分支。专为颅内血管设计的Willis覆膜支架的应用,彻底改变了颅内动脉瘤血管内治疗的传统理念,整个支架系统具有一定的柔顺性,有助于其通过颅内弯曲的血管系统,尤其是颈内动脉虹吸段,由于其操作简单,效果满意,为血管内治疗技术的发展提供了新的方向。     

支架置入术治疗慢性髂动脉闭塞

目的评价支架置入治疗慢性髂动脉闭塞的疗效及临床价值.方法在38例慢性髂动脉闭塞患者共46条病变血管中,发现髂总动脉闭塞18条,髂外动脉闭塞12条,髂总和髂外动脉均闭塞16条,分别行闭塞段开通,局部溶栓,血管腔内成形术(PTA)及支架置入等综合介入治疗.结果除3条髂动脉未能开通外,其余闭塞髂动脉均得以开通,其中43条闭塞髂动脉共置入54枚支架,支架覆盖长度为5～20 cm,平均为7.4 cm.4例髂总动脉起始部闭塞,采用"对吻式"技术球囊扩张后,双侧同时置入支架.随访3～62个月,平均29.5个月,1年、2年、4年支架初次通畅率分别为88%、84%、70%;再狭窄或闭塞的病例,行二次介入开通治疗后,支架的累积通畅率分别为94%,90%,84%.5例合并有主要并发症,包括1例形成动脉夹层;2例出现远端动脉栓塞;2例发生髂动脉破裂.结论支架置入术治疗慢性髂动脉闭塞是一项安全、有效的治疗措施,其中、远期疗效确切.