血管内支架成形术治疗脑供血动脉狭窄的研究

目的 探讨血管内支架成形术治疗脑供血动脉狭窄患者的近期疗效,并发症及安全性.方法 行血管内支架成形术治疗的19例脑供血动脉狭窄患者,其中颈内动脉起始段狭窄13例[5例表现为短暂性脑缺血发作(TIA),8例表现为脑梗死],椎动脉开口部狭窄6例,均表现为TIA.结果 19例患者支架全部成功置入,术前动脉狭窄程度平均为86%,术后残余狭窄程度平均为10%;明显增高的血流动力学恢复正常且持续保持;颈内动脉系统腩梗死患者NIHSS评分在术后明显改善.3例颈内动脉支架置入术患者出现一过性心率下降和血压下降,经药物治疗后均恢复正常.随访仅1例颈内动脉支架术后22周症状有所加重;1例椎动脉狭窄患者在术后19周出现1次TIA发作;其余患者术后随访6个月无症状复发.结论 血管内支架成形术是治疗脑供血动脉狭窄的一种安全、有效的治疗方法.     

血管内支架成形术治疗颅外颈动脉狭窄

目的　评价颅外颈动脉狭窄支架成形术的安全性及近期疗效。　方法　 2 0 0 0年 10月～ 2 0 0 2年 12月共收治颈动脉狭窄 16 4例 ,其中颅外分叉部颈内动脉狭窄 14 6例 ,单纯颅外段颈内动脉狭窄 13例 ,单纯颈总动脉狭窄 5例 ,采用自膨胀支架进行血管成形治疗。　结果　 16 4例支架植入均获得成功 ,血管狭窄程度从治疗前 (78 8± 13 6 ) %降低到 (10 2± 7 5 ) % ,围手术期无死亡及大卒中发生 ,1例出现短暂性脑缺血发作 (Transientischemicattack ,TIA) (0 6 % ) ,1例出现小卒中 (0 6 % )。14 5例获得随访 ,时间 3月～ 30月 (平均 8 9月 ) ,随访期间无TIA及卒中发生 ,无死亡。术后 6月数字减影脑血管造影随访 4 5例 ,再狭窄 1例 (2 2 % ) ,但无临床症状。　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 ,短中期结果令人满意。     

Apollo支架置入术治疗颈内动脉颅内段血管狭窄的疗效分析

目的探讨Apollo支架置入治疗颈内动脉颅内段血管狭窄的疗效。方法回顾性分析我院2013年9月至2015年9月经全脑血管造影检查证实狭窄程度70%的颅内段颈内动脉狭窄接受Apollo支架置入手术治疗的患者22例。临床随访采用NIHSS及mRS评分,并观察患者手术之后血管事件发生情况、症状性支架内再狭窄发生情况、狭窄血管与非狭窄血管供血区术前、术后相对达峰时间。结果 21例患者成功进行了支架置入术,手术成功率为95.45%(21/22)。术后30 d,发生同侧小卒中1例;术后1~6个月发生同侧小卒中1例;术后7~12个月发生同侧小卒中1例,术后1~2年发生对侧卒中1例,无致命性脑卒中事件或死亡事件。术后2年随访总血管事件发生率为22.73%(5/22)。发生症状性支架内再狭窄2例,再狭窄率为9.52%(2/21);手术成功患者狭窄血管供血区术前达峰时间(1.23±0.09)s、术后相对达峰时间(1.01±0.06)s,有统计学意义。手术前、手术1周、手术后30 d NIHSS评分分别为1.4±2.6、0.9±1.3、0.6±0.4,手术前、手术1周、手术后30 d mRS评分分别为1.3±1.1、0.7±1.0、0.4±1.1,与手术前比较,P0.05,有统计学意义。结论 Apollo支架置入治疗颅内动脉狭窄,围术期并发症发生率低,中远期随访症状性再狭窄发生率低,但其远期疗效尚需进一步探讨。     

颅内外动脉狭窄合并颅内动脉瘤同期血管内治疗的效果分析

目的探讨同期治疗颅内外动脉狭窄合并颅内动脉瘤的策略及临床效果。方法回顾性分析2013年4月至2018年9月于北京大学第一医院神经外科行同期血管内治疗的15例颅内外动脉狭窄合并颅内动脉瘤患者的临床资料。男性6例,女性9例,年龄(63.9±9.1)岁(范围:43~79岁);动脉狭窄部位共15处,狭窄程度为75%~95%,其中前循环8处,后循环7处;动脉瘤共17个,最大径(5.3±1.2)mm(范围:3~7 mm),其中前循环动脉瘤11个、后循环动脉瘤6个。患者均行同期动脉狭窄支架成形及动脉瘤栓塞术治疗。记录患者围手术期及术后临床症状、影像学资料及并发症情况。结果15处动脉狭窄均成功置入支架(残余狭窄<30%);17个动脉瘤中,10个行单纯弹簧圈栓塞,7个行支架辅助弹簧圈栓塞,均完全栓塞。围手术期1例患者出现轻微脑梗死症状,其余未发生手术相关并发症。术后随访(43.8±8.2)个月(范围:24~85个月),患者术后6~12个月均复查数字减影血管造影,其中2例出现无症状性支架内再狭窄,所有动脉瘤未见复发。截至末次随访时,患者均未出现颅内出血、缺血性卒中等相关症状。结论颅内外动脉狭窄合并颅内动脉瘤应根据血管狭窄的部位、程度及动脉瘤的大小、形态、位置、数量及两者的位置关系等因素综合分析,制定个体化的治疗策略,给予同期血管内治疗可能是一种安全、有效的治疗方法。     

Wingspan支架与冠脉支架在血管内支架成形术中的应用

目的 评价血管内支架成形术治疗颅内动脉狭窄的有效性和安全性. 方法 22例颅内动脉狭窄患者根据数字减影全脑血管造影(DSA)检查分为Wingspan组和冠脉球扩支架组,并给予血管内支架成形术治疗;比较两组手术成功率、术后动脉狭窄改善率及并发症发生率;随访半年,复查DSA. 结果 Wingspan组与冠脉支架组手术成功率分别为100％和90％,术后动脉狭窄改善率均＞70％,并发症发生率分别为16％和10％,两组间差异无统计学意义;Wingspan组与冠脉支架组手术时间分别为80分钟和102分钟,两者之间存在显著性差异.结论 血管内支架成形术可明显改善颅内动脉狭窄,降低脑血管事件的发生,安全有效.     

药物涂层球囊在症状性颅内椎基底动脉狭窄中的初步应用

目的探讨药物涂层球囊(DCB)在治疗症状性颅内椎基底动脉狭窄中的安全性及近期效果。方法回顾性分析2018年9月至2019年12月北京医院神经外科收治的16例应用DCB治疗的症状性颅内椎基底动脉狭窄患者的临床资料。其中男性15例, 女性1例, 年龄(63.1±9.2)岁(范围:48～77岁)。分析患者介入治疗情况、治疗效果及并发症情况。结果 16例患者共有19处颅内椎基底动脉狭窄进行经皮腔内球囊成形术治疗, 患者术前狭窄程度为75%(20%)[M(QR)], 所有DCB均成功置入并实施扩张, 术后残余狭窄率为0(20%);围手术期1例患者出现穿支血管闭塞所致后循环卒中。术后平均影像随访时间5.5个月, 均无再狭窄发生, 平均临床随访时间6.3个月, 均无新发症状。结论对于症状性颅内椎基底动脉狭窄患者, DCB血管成形术相对安全, 近期疗效满意。     

血管内支架成形术治疗肾动脉狭窄的临床研究

目的探讨血管内支架成形术治疗肾动脉狭窄的安全性及临床疗效。方法回顾性分析2008年8月~2015年9月我院行血管内支架置入术的85例肾动脉狭窄患者临床资料,观察其手术成功率、围手术期并发症发生率及临床疗效。结果 85例患者共成功植入85枚球扩式肾动脉支架,手术成功率100%。围手术期未发生动脉夹层、支架内血栓形成、急性肾功能衰竭等并发症。术后血压较术前呈逐渐下降趋势,服用降压药数减少,肾功能-血肌酐稳定。85例患者随访6个月~7年,平均(21.3±18.4)个月。随访期间发现肾动脉再狭窄8例(9.4%),均为无症状性狭窄。无责任血管相关的肾功能恶化。结论血管内支架成形术治疗肾动脉狭窄能解除血管狭窄,可有效改善血压,防止肾功能恶化,是一种安全有效的治疗方法。     

经皮血管内支架成形术在颅内血管疾病的初步应用

目的：探讨支架置入技术在治疗颅内血管疾病中的应用价值。方法：回顾性分析了13例成功置入支架的手术经验,探讨颅内支架置入的适应证、技术可行性及并发症的预防。13例颅内血管病变包括有症状的颅内血管狭窄患者7例,其中大脑中动脉狭窄3例,颈内动脉床突上段狭窄1例,椎动脉颅内段狭窄3例;颅内宽颈动脉瘤5例,包括1例基底动脉起始段宽颈动脉瘤,2例海绵窦段巨大宽颈动脉瘤以及2例颈动脉-海绵窦瘘栓塞后海绵窦段宽颈假性动脉瘤;静脉窦狭窄1例。结果：7例有症状的颅骨血管狭窄患者在支架置入后狭窄血管明显扩张,从原来平均狭窄83％下降到5％,其中1例出现了与技术有关的并发症。5例宽颈动脉瘤患者（包括2例假性动脉瘤）通过支架辅助成功地达到了囊内栓塞。横窦狭窄患者在其一侧置入支架后,颅内压力明显下降,临床症状减轻,8个月后随访症状完全消失。结论：支架置入血管内成形技术,可以成功地应用于颅内血管疾病的治疗,但对于适应证的选择和长期的疗效有待于进一步的观察确定。     

血管内支架成型术治疗青壮年大脑中动脉狭窄的临床研究

目的:研究青壮年大脑中动脉(MCA)M1段狭窄血管内支架成形术的安全性和疗效。方法:47例大脑中动脉狭窄的患者,在静脉复合麻醉条件下采用球扩支架对大脑中动脉M1段行血管内支架成型术(PTA),术前3～5天口服阿司匹林肠溶片300mg及氯吡格雷片75mg,均为1次/天,术中、术后严格控制血压,监测生命体征。结果:47例患者大脑中动脉M1段狭窄约70%～99%,其中有46例患者支架得以成功置入,残余狭窄约0%～20%,术后大脑中动脉M1段直径狭窄率明显降低,与术前相比有明显差异(P<0.01)。短暂性脑缺血发作症状均得到控制,脑梗死患者症状得到明显改善。结论:支架血管成形术是治疗大脑中动脉狭窄的一种安全、有效的治疗方法,应积极防治再灌注损伤等合并症,对于血管高度迂曲的患者要做好术前评估。     

颈内动脉狭窄处扭曲的血管内治疗

目的 探讨血管内支架成形术治疗颈内动脉狭窄处扭曲的必要性、可行性和安全性.方法 选择2003年12月至2009年12月经数字减影血管造影(DSA)检查证实的症状性颈内动脉狭窄且狭窄处伴扭曲的12例患者,采用血管内支架成形术处理颈动脉狭窄伴扭曲,分析其临床、影像学、支架成形术和随访观察资料,评价治疗效果.结果 12例颈内动脉狭窄伴扭曲的患者全部成功实施血管内支架成形术,支架置入成功率100%,无支架相关死亡或致残.12例患者共置入自膨式支架14枚,平均狭窄率由术前的85.6%下降至11.2%;扭曲角度(Metz观测分类法)由术前＜90°变为＞120°;无围手术期短暂性脑缺血发作(TIA)和脑卒中发生,临床症状改善或消失.临床随访6～72个月,发生支架同侧和对侧TIA各1例;5例患者行DSA检查,其中1例发生再狭窄并在支架远端发生新的扭曲,再次支架置入治疗,2年后CT血管造影(CTA)复查未见扭曲和支架内再狭窄;另外7例行颈部血管超声检查,未见再狭窄和扭曲.结论 血管内支架成形术治疗颈内动脉狭窄伴扭曲,技术上是可行、安全的,可能有助于减少脑缺血发生,但有待于进一步观察.

Abstract：

Objective To study the necessity, feasibility, security of carotid angioplasty and stenting (CAS) for symptomatic carotid stenosis combined with kinking. Methods Twelve patients with symptomatic carotid stenosis and kinking demonstrated by digital subtraction angiography (DSA) received CAS from December 2003 to December 2009. There were 9 male and 3 female patients, age ranged from 59 to 77 years(mean 69.3 years). All the patients' clinical, imaging, intervention and follow up data were collected and analyzed. Results All CAS procedures were successfully performed with 14 self-expandable stents placed. The mean degree of stenosis was reduced from 85. 6% before stenting to 11.2% after stenting,the angle of kinking, according to Metz' category, were improved from less than 90° to more than 120° in each case. No perioperative procedure related stroke and tranient ichemic attack (TIA) occurred. The clinical symptoms and signs of cerebral ischemia were improved or disappeared for all patients. During follow-up of these 12 patients for 6 to 72 months, one patient experienced ipsilateral carotid territory TIA and another patient experienced contralateral carotid territory TIA. DSA follow up of 5 patients demonstrated 1 case with in-stent restenosis and arterial kinking remote to the stent of internal carotid artery. CAS were performed again and CT angiography follow up demonstrated no kinking and restenosis 2 years after the intervention. Duplex scan of the other 7 patients demonstrated neither kinking nor restenosis. Conclusions CAS seems to be feasible and safe for the patients with symptomatic kinking and stenosis, and maybe helpful to lower the risk of cerebral ischemia, but further study is needed.     

Improved cerebral perfusion after simultaneous stenting for tandem stenoses of the internal carotid artery--two case reports

Two patients with extracranial internal carotid artery (ICA) stenosis and tandem stenosis of the ipsilateral intracranial ICA were treated simultaneously by angioplasty with stenting. A 68-year-old man who presented with neovascular glaucoma had 90% stenosis of the right cervical ICA and 80% stenosis of the ipsilateral petrous ICA. A 74-year-old man who suffered from transient ischemic attack had 75% stenosis of the left cervical ICA and 90% stenosis of the ipsilateral cavernous ICA. Hemodynamic compromise was confirmed in both patients. Tandem stenting of both extracranial and intracranial ICA stenoses was performed simultaneously in both patients without complications. Poststenting angiography demonstrated excellent dilation of both lesions and normalization of cerebral perfusion. Simultaneous tandem stenting for extracranial ICA stenosis with intracranial tandem stenosis is less invasive than open surgery in high-risk patients with hemodynamic compromise, especially if the major lesion responsible for cerebral hypoperfusion is difficult to determine.     

Emergency stenting for iatrogenic occlusion of internal carotid artery during percutaneous transluminal angioplasty: a case report

The authors report the case of a 68-year-old male who underwent emergency stenting for iatrogenic occlusion of the internal carotid artery while he was receiving percutaneous transluminal angioplasty. He presented with a 1-month history of transient ischemic attacks with right-sided hemiparesis. Carotid angiography revealed a 95% eccentric stenosis at the origin of the left internal carotid artery. As the stenotic lesion was higher than the level of the third cervical vertebral body, percutaneous transluminal angioplasty was performed instead of carotid endarterectomy. During the procedure, the left internal carotid artery was dissected, then obstructed completely with rapid deterioration of his neurological condition. The Palmaz-Schatz stent was successfully deployed over the site of dissection to restore normal patency through the dissected carotid artery. Following emergency stenting, his neurological signs quickly subsided. Since then, with oral administration of antiplatelet medication, he has suffered no recurrence of cerebral ischemic events. Echo-ultrasonography 4 months after stent implantation showed good patency of the stented segment. It has been reported that angioplasty is indicated for high-risk patients or surgically inaccessible lesions in stenotic disorders of the internal carotid artery. However, there are several complications reported, including intimal dissection and restenosis. The present case emphasizes the usefulness of emergency stenting when occlusion of the internal carotid artery is complicated during percutaneous transluminal angioplasty.     

颅外段颈动脉狭窄的治疗策略

目的：探讨颅外段颈动脉粥样硬化性狭窄的治疗方法。方法回顾性分析上海中山医院血管外科2012年1～6月51例颅外段颈动脉粥样硬化性狭窄患者的临床资料,16例行颈动脉内膜剥脱术（carotid endarterectomy,CEA）,35例行颈动脉支架置入术（ carotid artery stenting ,CAS）。结果51例手术均获成功,1例CAS术后即刻脑卒中,1例CEA术后第3天短暂性脑缺血发作（transient ischemic attack,TIA）,1例CAS术后颈动脉窦压迫。全组术后随访9～15个月,平均13．6月,复查颈动脉B超,无严重再狭窄。结论根据颅外段颈动脉粥样硬化性狭窄患者的相关医学资料,对于有下列情况之一的患者我们倾向于行CEA：①6个月内1次或多次TIA,且颈动脉狭窄度≥70％;②6个月内1次或多次轻度非致残性卒中发作,症状或体征持续超过24小时且颈动脉狭窄度≥70％;③对于经颈部血管CTA和颈动脉全脑血管造影发现的颈动脉狭窄段≥2 cm。对于有下列情况之一的患者我们倾向于行CAS：①无症状性颈动脉狭窄度≥70％;②有症状性狭窄度范围50％～69％;③无症状性颈动脉狭窄度＜70％,但血管造影或其他检查提示狭窄病变处于不稳定状态。     

Improved cerebral perfusion after stenting of a petrous carotid stenosis: technical case report.

OBJECTIVE AND IMPORTANCE: Atherosclerotic occlusive disease of the intracranial vasculature is associated with increased risk of systemic vascular occlusive disease and stroke. Therapeutic options have included anticoagulation therapy, antiplatelet therapy, or, in a limited number of patients, extracranial-intracranial vascular bypass procedures. We report a patient who had improved cerebral perfusion with silent watershed zone infarctions after endovascular stenting of a severe petrous segment carotid stenosis. CLINICAL PRESENTATION: A 73-year-old man with severe coronary artery disease and unstable angina was referred for treatment of a 90% right petrous carotid artery stenosis before coronary artery bypass grafting. A brain single-photon emission computed tomographic scan using 99mTc-bicisate revealed diminished perfusion throughout the right internal carotid artery territory, particularly in posterior watershed zones. TECHNIQUE: The patient underwent transfemoral placement of a 7-French introducer sheath, followed by a 7-French guide catheter. Urokinase (225,000 U) was infused through a microcatheter placed proximal to the lesion. No changes were noted in lesion morphology after this infusion. A microguidewire was navigated across the lesion. Subsequent balloon angioplasty with a coronary artery balloon was performed twice, followed by placement of a 4- x 12-mm coronary stent. CONCLUSION: Selective internal carotid artery angiography after stenting revealed markedly improved flow. A brain 99mTc-bicisate single-photon emission computed tomographic scan performed within 24 hours of stent placement, revealed significantly improved perfusion within the right internal carotid artery territory. Two perfusion voids suggestive of embolic stroke were noted; both were clinically silent. The patient had uncomplicated coronary artery bypass grafting 72 hours later. Five months postoperatively, he remains at home, living independently and with intact neurological function. Intracranial stenting for severe atherosclerotic stenosis is technically possible. However, its ultimate clinical role remains to be determined.     

颈动脉狭窄的介入治疗(附40例报告)

目的 总结我科40例颈动脉支架置入术治疗颈动脉狭窄的经验。方法2000年10月～2002年7月40例颈动脉狭窄行腔内成形、支架置入术，共放支架43个，其中Wallstent支架39个，Smart支架4个。应用脑保护装置5例。结果所有病人都完成支架置入，颈内动脉口都恢复到4min以上。术中出现轻度卒中2例，较重卒中2例：1例术中出现左眼视野缺损，3月后仍有残余症状；1例术中出现意识丧失、右侧肢体偏瘫，经救治神志恢复。并发症发生率10％(4／40)，严重卒中发生率5％(2／40)，应用脑保护装置的病人无并发症发生。结论颈动脉支架置入术是治疗颈动脉狭窄的有效手段，用脑保护装置时安全保证更高。     

In-stent recurrent stenosis after carotid artery stenting: life table analysis and clinical relevance

OBJECTIVES: Carotid artery stenting has been proposed as an alternative to carotid endarterectomy in cerebral revascularization. Although early results from several centers have been encouraging, concerns remain regarding long-term durability of carotid artery stenting. We report the incidence, characteristics, and management of in-stent recurrent stenosis after long-term follow-up of carotid artery stenting. METHODS: Carotid artery stenting (n = 122) was performed in 118 patients between September 1996 and March 2003. Indications included recurrent stenosis after previous carotid endarterectomy (66%), primary lesions in patients at high-risk (29%), and previous ipsilateral cervical radiation therapy (5%). Fifty-five percent of patients had asymptomatic stenosis; 45% had symptomatic lesions. Each patient was followed up with serial duplex ultrasound scanning. Selective angiography and repeat intervention were performed when duplex ultrasound scans demonstrated 80% or greater in-stent recurrent stenosis. Data were prospectively recorded, and were statistically analyzed with the Kaplan-Meier method and log-rank test. RESULTS: Carotid artery stenting was performed successfully in all cases, with the WallStent or Acculink carotid stent. Thirty-day stroke and death rate was 3.3%, attributable to retinal infarction (n = 1), hemispheric stroke (n = 1), and death (n = 2). Over follow-up of 1 to 74 months (mean, 18.8 months), 22 patients had in-stent recurrent stenosis (40%-59%, n = 11; 60%-79%, n = 6; > or =80%, n = 5), which occurred within 18 months of carotid artery stenting in 13 patients (60%). None of the patients with in-stent recurrent stenosis exhibited neurologic symptoms. Life table analysis and Kaplan-Meier curves predicted cumulative in-stent recurrent stenosis 80% or greater in 6.4% of patients at 60 months. Three of five in-stent recurrent stenoses occurred within 15 months of carotid artery stenting, and one each occurred at 20 and 47 months, respectively. Repeat angioplasty was performed once in 3 patients and three times in 1 patient, and repeat stenting in 1 patient, without complications. One of these patients demonstrated asymptomatic internal carotid artery occlusion 1 year after repeat intervention. CONCLUSIONS: Carotid artery stenting can be performed with a low incidence of periprocedural complications. The cumulative incidence of clinically significant in-stent recurrent stenosis (> or =80%) over 5 years is low (6.4%). In-stent restenosis was not associated with neurologic symptoms in the 5 patients noted in this cohort. Most instances of in-stent recurrent stenosis occur early after carotid artery stenting, and can be managed successfully with endovascular techniques.     

Transcervical carotid stenting with internal carotid artery flow reversal: feasibility and preliminary results

OBJECTIVE: Transfemoral carotid artery stenting (CAS), with or without distal protection, is associated with risk for cerebral and peripheral embolism and access site complications. To establish cerebral protection before crossing the carotid lesion and to avert transfemoral access complications, the present study was undertaken to evaluate a transcervical approach for CAS with carotid flow reversal for cerebral protection. METHODS: Fifty patients underwent CAS through a transcervical approach. All patients with symptoms had greater than 60% internal carotid artery (ICA) stenosis, and all patients without symptoms had greater than 80% ICA stenosis. Twenty-one patients (42%) had symptomatic disease or ipsilateral stroke, and 8 patients (16%) had contralateral stroke. Four patients (8%) had recurrent stenosis, 7 patients (14%) had contralateral ICA occlusion, and 1 patient (2%) had undergone previous neck radiation. Twenty-seven procedures (54%) were performed with local anesthesia, and 23 (46%) with general anesthesia. Using a cervical cutdown, flow was reversed in the ICA by occluding the common carotid artery and establishing a carotid-jugular vein fistula. Pre-dilation was selective, and 8-mm to 10-mm self-expanding stents were deployed and post-dilated with 5-mm to 6-mm balloons in all cases. RESULTS: The procedure was technically successful in all patients, without significant residual stenoses. No strokes or deaths occurred. There was 1 wound complication (2%). All patients were discharged within 2 days of surgery. Mean flow reversal time was 21.4 minutes (range, 9-50 minutes). Carotid flow reversal was not tolerated in 2 patients (4%). Early in the experience, carotid flow reversal was not possible in 1 patient, and there were 1 major and 3 minor common carotid artery dissections, which resolved after stent placement. One intraoperative transient ischemic attack (2%) occurred in 1 patient in whom carotid flow was not reversed, and 1 patient with a contralateral ICA occlusion had a contralateral transient ischemic attack. At 1 to 12 months of follow-up, all patients remained asymptomatic, and all but 1 stent remained patent. CONCLUSION: Transcervical CAS with carotid flow reversal is feasible and safe. It can be done with the patient under local anesthesia, averts the complications of the transfemoral approach, and eliminates the increased complexity and cost of cerebral protection devices. Transcervical CAS is feasible when the transfemoral route is impossible or contraindicated, and may be the procedure of choice in a subset of patients in whom carotid stenting is indicated.     

腔内支架成形术治疗颈动脉狭窄(附64例报告)

目的：介绍颈动脉腔内支架成形术的基本方法，总结64例经验体会，探讨该术式治疗颈动脉狭窄的操作和并发症的预防。方法：64例颈动脉狭窄病人行腔内支架成形术，共放支架66个，其中Wallstent支架41个，Smart支架22个．OptiMed支架3个。应用脑保护装置26例。结果：术中出现较重卒中2例：1例术出现左眼视野缺损．3个月后仍有残余症状：1例术中出现意识丧失、右侧肢体偏瘫，经救治神志恢复。出现轻度卒中3例。10例出现一过性血压降低、心动过缓，其后逐渐恢复。1例术后出现原有神经系统症状加重。神经系统并发症发生率为7．88％，严重卒中是3.13％。循环系统并发症是15．63％。应用脑保护装置的病人仅有1例发生一过性神经系统并发症。结论：颈动脉腔内支架成形术是治疗颈动脉狭窄的有效手段，在有经验的医师操作下，治疗是安全的。使用脑保护装置可明显减少神经系统并发症。     

A successful treatment with carotid arterial stenting for symptomatic internal carotid artery severe stenosis with ipsilateral persistent primitive hypoglossal artery: case report and review of the literature

A 68-year-old male presented with a syncopal attack subsequent to acute myocardial infarction. His ultrasonographic and radiological examination revealed severe left internal carotid artery (ICA) stenosis and the presence of a persistent primitive hypoglossal artery (PPHA) immediately distal to the stenosis. The bilateral anterior and left middle cerebral arteries, and the vertebrobasilar system were opacified via the stenotic ICA. Carotid arterial stenting was selected as the treatment method because the lesion was high and a shunt placement during carotid endarterectomy was considered to be technically difficult. A self-expanding stent was successfully deployed with flow control, and the patient was discharged six days after surgery without any neurological deficit. There are sixteen reported cases including ours of PPHA associated with ICA stenosis presenting with ischemic attacks of the vertebrobasilar system. To the best of our knowledge, the current case is the first report of a cervical ICA stenosis with ipsilateral carotid-basilar anastomosis treated with carotid arterial stenting.