经皮腔内血管支架成形术治疗颅内外动脉狭窄30例报道

目的介绍颅内外动脉狭窄经皮腔内血管支架成形术的基本方法，总结30例治疗经验体会及并发症的发生与防治。方法30例患者38处颅内外动脉狭窄经皮腔内血管支架成形术，共置入支架40个，其中颈内动脉开口18枚，颈内动脉C1段7枚、C3-C5段8枚，锁骨下动脉2枚，椎动脉开口5枚；应用保护伞17例。结果技术成功率100％。21处术后残余狭窄率小于10％，11处为10％～20％，6处为20％～30％。17例脑保护装置均成功释放及回收。7例TIA患者和4例表现有明显头昏的患者症状即刻消失或好转；6例行颈内动脉支架植入术后原来难以控制的高血压病明显降低。1例术后出现持续低血压；2例术中有轻度脑血管痉挛现象；1例入路困难，手术时间明显延长；1例术后出现轻度的高灌注综合征。随访中出现再狭窄1例、术后抑郁症1例。结论颅内外动脉狭窄经皮腔内血管支架成形术是治疗颅内外脑供血动脉狭窄新的有效治疗方法，在严格掌握适应症和有经验的医生操作下治疗是安全的。     

支架治疗颅内动脉狭窄6例临床分析

目的观察支架治疗颅内动脉狭窄的临床效果。方法选择症状性颅内动脉狭窄6例,其中颈内动脉颅内段1例,大脑中动脉M1段3例,椎动脉颅内段2例。狭窄程度60％-95％。在全麻或局麻下,以Seldinger技术行右股动脉穿刺,在微导丝导引下将支架准确定位后释放。结果6例均手术成功,5例患者狭窄血管恢复到正常管径,1例椎动脉狭窄未达到正常管径75％的患者用球囊进行后扩张,达正常管径的90％。结论支架治疗颅内动脉狭窄即刻效果满意,5例患者随访6-12个月,均未出现与术前病灶相关的临床表现。     

药物与支架成形术治疗颅内外血管狭窄的疗效比较

目的 回顾性探讨症状性脑供血动脉狭窄患者的药物治疗及支架治疗对疾病转归和预后的影响.方法 筛选符合条件的经数字减影血管造影术(DSA)证实脑供血动脉存在中-重度狭窄的患者,分析患者住院期间终点事件(卒中或死亡事件)及出院后至随访日期终点事件(病变血管供血区卒中事件)发生情况.结果 (1)进行住院期间终点事件调查的患者421例,接受经皮腔内血管支架成形术(PTAS)者及单纯药物治疗者分别为256例,165例,两组分别有28例(10.94%)和2例(1.21%)发生了住院期间终点事件,分别有16例(6.25%)和0例发生了严重终点事件(致残或致死性终点事件),差异均有统计学意义(P<0.01).(2)以上患者出院后共随访106例,PTAS联合药物治疗及单纯药物治疗者分别为60例和46例,两组分别有5例(8.33%)和10例(21.74%)发生了出院后至随访日期终点事件(P=0.05);2例(3.33%)和6例(13.04%)发生了严重终点事件,差异无统计学意义(P>0.05).结论 PTAS围手术期并发症较高,但从长远效益来看,较单纯药物治疗,PTAS联合药物治疗可有效防止病变血管供血区卒中事件的发生.     

经皮静脉窦支架成形术治疗颅内静脉窦狭窄

采用动脉内支架辅助治疗冠状动脉、颈内动脉颅外段甚至颈内动脉颅内段狭窄的方法，能够明显改善患预后，已经许多临床观察结果证明长期疗效十分满意。由于颈静脉球及静脉窦汇等处解剖结构的特点，以及静脉窦压力低放置支架后易形成血栓等原因，目前对应用静脉系统放置支架辅助治     

Wing span 支架治疗症状性颅内动脉狭窄的临床研究

目的：探讨Wingspan颅内动脉支架系统治疗症状性颅内动脉狭窄的有效性、安全性及手术并发症的防治。方法应用Wingspan颅内动脉支架系统治疗符合介入治疗标准的11例颅内动脉狭窄的患者,于颈内动脉颅内段、大脑中动脉M1段、椎动脉颅内段及基底动脉狭窄处共置入12枚Wingspan支架,观察手术前后患者临床症状、狭窄率及并发症发生情况,评估手术安全性,术后平均随访12个月。结果10例患者支架置入顺利,一次性成功,支架定位准确;1例术中出现支架前移,未覆盖斑块,再置入Wingspan支架1枚。术后1例出现TIA发作,其余病例未出现相应供血区域新发缺血事件,无颅内出血并发症。随访12个月,发现2例出现再狭窄,狭窄率＞50％。结论 Wingspan颅内动脉支架系统治疗颅内动脉狭窄安全、有效,中短期并发症低。     

颅内动脉狭窄的支架成形术与内科治疗的疗效观察

目的比较血管内支架成形术与内科药物治疗对颅内动脉狭窄的疗效.方法符合入选标准的96例颅内动脉狭窄患者根据其经济承受能力及自愿原则,分为支架成形术（SAA）组30例和内科药物治疗组66例.每半年临床随访一次,随访时间6-36个月,平均18.9个月.详细记录（1）随访期间的卒中复发率及病死率;（2）MMSE评分;（3）mRS（modified rankin scale）评分,以mRS 2分以下为生存质量高,3分以上为生存质量差.结果SAA组有2例（6.7%）发生原狭窄动脉供血区的轻微卒中,内科治疗组10例（15.2%）再发卒中（P＜0.01）;MMSE评分提示SAA组患者的认知功能改善优于内科治疗组（P＜0.05）;两组mRS评分比较提示SAA组患者的生存质量优于内科治疗组.结论血管内支架成形术治疗颅内动脉粥样硬化性狭窄是安全的、可行的,其疗效优于内科保守治疗.     

症状性颅内动脉狭窄血管内支架成形术的疗效观察

目的观察症状性颅内动脉狭窄患者血管内支架成形术的疗效和安全性。方法对4例症状性颅内动脉狭窄患者行血管内支架成形术,通过临床症状、数字减影血管造影(DSA)、经颅多普勒(TCD)评价其疗效,并随访7～10个月。结果4例患者手术全部成功,术后即刻造影显示狭窄程度明显改善,平均狭窄程度从术前的75%下降到8.0%。术中发生短暂性抽搐1例,无脑栓塞及颅内出血等并发症。术后随访7～10个月,未见新的TIA或脑梗死,TCD复查未见再狭窄。结论血管内支架成形术是治疗症状性颅内动脉狭窄的一个相对安全、有效的手段。     

支架成形术治疗颅内动脉狭窄的应用

目的:总结本组颅内支架成形术的的手术成功率、并发症发生率及随访情况,探讨该治疗方法的可行性、有效性和安全性。方法:回顾性分析2004年4月至2006年5月本院应用支架成形术治疗的18例颅内动脉狭窄患者的手术成功率、围手术期并发症发生率及随访情况。结果:18例症状性颅内动脉狭窄患者共19处病变,手术成功率94.7%;术前平均狭窄率69.2±8.4%;术后残余狭窄平均6.9±1.4%;围手术期并发症发生率11.1%;平均随访10.8±6.7月,TCD复查显示2例发生再狭窄,但无脑梗塞、TIA、眩晕等脑血管事件发生。结论:本研究显示,颅内支架成形术在技术上是可行的,但其有效性和安全性尚需进一步的研究。     

血管内支架成形术治疗颅内动脉狭窄的临床研究

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39例颅内动脉狭窄患者根据数字减影全脑血管造影(DSA)检查分为前循环组[26例,11例为短暂性脑缺血发作(TIA),15例为脑梗死(CI)]和后循环组(13例,3例为TIA,10例为CI),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6~12个月,复查DSA;比较手术前、后CI患者改良Rankin量表(mRS)评分和Barthel指数(BI)的变化。结果前后循环组手术成功率分别为92.3%和100%,术后动脉狭窄改善率均>70%,并发症发生率分别为19.2%和7.7%,两组间差异无统计学意义;随访期间前循环组10例、后循环组5例复查DSA,两组各有1例出现动脉再狭窄50%;术后6个月及12个月两组CI患者mRS评分、BI均较术前显著改善(均P<0.05);两组均无TIA及CI发生。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。     

血管内支架成形术治疗症状性颅内动脉狭窄

目的 初步总结颅内动脉狭窄血管内支架成形术的疗效及其治疗经验。方法 18例患者计19处颅内动脉狭窄(前循环11处、后循环8处)行球囊膨胀支架血管内成形术,术前平均狭窄(80.3±7.92)％,平均狭窄长度(5.89±1.82)mm。结果 19处动脉狭窄均成功支架植入,狭窄降至(4.68±9.53)％,无颅内出血、支架内急性闭塞手术并发症。短期随访(5～24个月)脑缺血症状均未再发作;脑血管造影随访15例,1例见支架内内膜增生但无再狭窄。结论 血管内支架成形术治疗颅内动脉狭窄是一种安全、有效的方法,但远期疗效还有待于进一步观察。     

Long-Term Effects on Preventing Stroke after Endovascular Treatment or Bypass Surgery for Intracranial Arterial Stenosis

Background: Intracranial arterial stenosis (ICAS) is an important cause of ischemic stroke worldwide due to its higher risk of recurrence with medical therapy. Although some large randomized studies failed to show the superiority of surgical treatment compared with medical therapy, the results of medical therapy are not sufficient. There are patients who still benefit from surgical treatment. This retrospective analysis aimed to evaluate the long-term efficacy of surgical therapy with percutaneous transluminal angioplasty and/or stenting (PTA/PTAS) or extracranial-intracranial (EC/IC) bypass surgery for patients with ICAS. Methods: Between October 2005 and December 2016, 55 ICAS patients were treated with PTA/PTAS or EC-IC bypass surgery. Their electronic medical records were retrospectively reviewed and analyzed. The primary outcome was all adverse events beyond 30 days after a revascularization procedure. Results: We performed 21 cases (35%) of PTA, 4 cases (7%) of PTAS, and 34 cases (58%) of EC-IC bypass surgery and the median follow-up duration was 66 months (range 1-144 months). The occurrence rate of the primary outcome was 10.2% and only 1 patient (1.8%) experienced ipsilateral disabling ischemic stroke beyond 30 days. The long-term functional independent survival rate was 83.6%. Conclusions: We demonstrated a long-term favorable outcome of combined surgical intervention for ICAS patients with PTA/PTAS and EC-IC bypass surgery, and the result was better than previously reported outcomes of medical therapy. Additional multicenter studies are required to draw firm conclusions on the efficacy of reduction of recurrent stroke in patients with ICAS.     

锁骨下动脉闭塞支架植入术

锁骨下动脉闭塞引起有椎-基底动脉供血不足、患侧肢体缺血表现等,如共济失调、眩晕、运动时出现肢体疼痛、麻木、乏力、苍白等。目前主要采用血管内支架成形术,当病变完全闭塞或接近锁骨下动脉和椎动脉开口时可考虑选择外科手术治疗。本病例闭塞近心端过短、闭塞时间长,按目前的腔内治疗和外科手术方法,风险大,我们采用长鞘衬管技术、双向造影/双向导丝打通技术成功进行了腔内支架植入术。     

Submaximal angioplasty and staged stenting for severe posterior circulation intracranial stenosis

Introduction: Severe medically refractory intracranial stenosis portends a grave prognosis. Recent advances in stent technology have enabled clinicians to treat these lesions. Evidence in the coronary literature suggests that stenting without predilation angioplasty is as safe and effective as stenting immediately preceded by predilation angioplasty for the treatment of severely stenotic lesions. Because of marked differences in vessel histology and differences in the sensitivity of the cerebral and coronary vascular beds to embolic insult, direct stenting of severe intracranial stenoses may be more prone to neurological complications than a conventional or staged stenting procedure. Methods: We reviewed our clinical experience with conventional, direct, and staged stenting for high-grade stenoses involving the posterior intracranial circulation. We also reviewed the literature and experimental data supporting the rationale for staged stenting. Results: In our experience, no permanent neurological morbidity was identified in four patients treated with a staged approach. In contrast, one of three patients with conventional stenting of the basilar artery and two of four patients treated with direct basilar stenting had permanent neurological sequelae. Conclusion: For patients with high-grade posterior circulation intracranial stenoses involving the perforator-rich zones of the basilar artery, staged stenting may reduce procedure-related morbidity. A staged approach allows for plaque stabilization resulting from postangioplasty fibrosis, which may protect patients from “snowplowing,” embolic shower of debris, or dissection. Further clinical, in vivo, and histological investigation is warranted.     

缺血性卒中患者颅内外血管狭窄率研究

目的:研究缺血性卒中患者颅内外血管狭窄或闭塞的发生率,并对其相关病因进行分析。方法:对经CT/MRI/DWI诊断的缺血性卒中患者的人口构成情况进行登记,了解其相关危险因素。并经TCD和/或MRA了解其颅内外血管狭窄或闭塞的情况。结果:579例缺血性卒中患者中,颅内外血管狭窄的发生率为70.98%(411/579例);411例大动脉狭窄或闭塞患者中,以大脑中动脉狭窄或闭塞最常见(64.48%),其次为颈内动脉(50.36%)。大动脉狭窄或闭塞的主要原因为动脉粥样硬化,引起动脉粥样硬化的危险因素的发病率依次为:高血压病(77.24%),吸烟(63.68%)。通过Logistic回归分析发现,糖尿病、高血压、吸烟是血管狭窄的主要相关危险因素(P值均<0.05)。结论:国内缺血性卒中患者颅内外血管狭窄或闭塞的发生率高,其主要病因为动脉粥样硬化,糖尿病是大动脉狭窄或闭塞的最主要危险因素。     

腔内支架成形术治疗椎动脉起始部狭窄

目的探讨腔内支架成形术治疗椎动脉起始部狭窄的疗效。方法对16例椎动脉起始部狭窄的患者行腔内支架成形术治疗,成功置入17枚球囊扩张支架,无1例发生严重并发症。结果术后造影狭窄程度明显改善,残余狭窄<20%。在6个月的临床随访中,16例患者均无脑缺血发作及再狭窄发生。颈动脉彩超示血流通畅,未见内膜过度增生。结论腔内支架成形术是治疗椎动脉起始部狭窄的安全、有效的方法,其长期效果还需进一步随访研究。     

Intracranial artery dissection

The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be identified: a subintimal or subadventitial dissection. It is suggested that a subintimal dissection results in luminal stenosis, thromboembolism and subsequently cerebral ischaemia, whilst a subadventitial IAD could result in the formation of a pseudo‐aneurysm and compression on brainstem or cranial nerves. Rupture of such a dissecting aneurysm causes SAH. The exact cause of IAD remains unknown but several factors are associated with its development. Diagnosis is based on clinical presentation and specific features seen on multimodal neuroimaging. The management of IAD depends on the clinical presentation. In the case of cerebral ischaemia, anticoagulants or antiplatelet agents are used, whilst in the case of SAH endovascular treatment is primarily advocated. Prognosis depends on clinical presentation. Presentation with SAH has a worse prognosis.     

颈动脉狭窄患者血管成形和支架植入术后血流动力学的改变

目的探讨颈动脉狭窄患者血管成形和支架植入术(CAS)后血流动力学的改变。方法给31例颈动脉狭窄患者行CAS。在术前、术后第1 d、3个月及1年时进行颈动脉彩色多普勒血流显像(CDFI)检查。比较手术前后颈动脉狭窄段的血管内径、峰值流速(PSV)和舒张末期流速(EDV)。结果与术前比较,患者术后各时间点颈动脉的血管内径明显增大,PSV和EDV明显降低(均P0.01)。与术后第1 d比较,术后3个月的颈动脉CDFI各项指标的差异无统计学意义;与术后第1 d比较,术后1年的颈动脉血管内径缩小(P0.05),PSV和EDV的差异无统计学意义。结论 CAS术后颈动脉狭窄得到缓解,血流动力学指标显著改善。术后1年时部分患者出现支架处血管再狭窄,但血流动力学无明显改变。     

颈动脉内膜剥脱术治疗中重度颈动脉狭窄的临床研究

目的以颈动脉支架置入术(CAS)为对照,分析颈动脉内膜剥脱术(CEA)在治疗中重度颈动脉狭窄的临床价值。方法将100例颈动脉狭窄患者按手术方法不同分为观察组(CEA)和对照组(CAS),记录2组围术期手术相关并发症;记录手术用时、住院时间、治疗费用;随访12个月,记录2组包括死亡在内的不良反应发生率及改良Rankin评分情况。结果观察组与对照组在围术期手术相关并发症、住院时间、术后6个月不良反应发生率及改良Rankin评分比较均无明显差异(P均0.05)。但观察组治疗经费低于对照组(P0.05)。结论颈动脉支架置入术治疗中重度颈动脉狭窄效果良好,术后近期和远期疗效及治疗安全性与颈动脉内膜剥脱术相当,但颈动脉内膜剥离术费用成本较低,并发症少。