脑保护装置下血管内支架成形术治疗颈动脉狭窄的临床研究

目的探讨和总结脑保护装置下支架成形术治疗颈动脉狭窄的技术及疗效。方法分析64例颈动脉狭窄患者在脑保护装置下使用自膨式支架行颈动脉支架成形术(CAS)治疗的临床资料。结果 64例全部技术成功,共放置支架71枚,脑保护装置全部收回,颈动脉病变残余狭窄≤20%,临床症状消失。结论脑保护装置下自膨式支架成形术治疗颈动脉狭窄是一种安全有效的方法,但其长期疗效仍需进一步观察。     

颈动脉支架成形术在高手术风险颈动脉狭窄治疗中的应用

目的：探讨应用Onyx胶栓塞颅内动静脉畸形（CAVM）的治疗效果.方法：2008年1月～2009年12月,经股动脉穿刺,采用血管介入Onyx胶栓塞治疗CAVM 50例,其中畸形血管团直径＜3.0 cm者10例,3.0～6.0 cm者29例,＞6.0 cm者11例.结果：50例CAVM患者,一次栓塞治疗后畸形血管团栓塞达90%以上者12例,栓塞在90%以下者38例均行多次栓塞或联合手术、放射治疗.并发颅内出血症2例,其中1例术后24h死亡.44例术后随访3～18个月,无一例CAVM复发.结论：Onyx胶是治疗CAVM较为理想的栓塞材料,血管内栓塞治疗CAVM有良好的疗效.     

经皮颈动脉支架植入术治疗颈动脉狭窄的近、远期预后和生存率分析

目的:回顾性分析颈动脉狭窄患者经皮颈动脉支架植入术治疗预后。方法:收集本院2004-02—2014-03收治的214例颈动脉狭窄患者,依其治疗方法不同,分为经皮颈动脉支架植入组(介入治疗组,n=109)以及采用阿司匹林和氯吡格雷保守治疗组(药物治疗组,n=105),随访60个月。比较两组患者治疗后在院期间、近期(出院后1个月)及远期(出院后60个月)随访其冠脉缺血、脑卒中发生率及生存率的差异。结果:两组患者随访时间均为(48.9±16.4)个月,随访率差异无统计学意义(92.9%vs 93.2%)。术后在院期间:介入治疗组无病例死亡,2例出现脑缺血,5例出现冠脉缺血;药物治疗组亦无死亡病例,5例发生脑缺血,4例发生冠脉缺血。两组患者在院期间上述结局的差异均无统计学意义(P>0.05)。术后近期随访:介入治疗组1例死亡,2例发生脑卒中,3例发生急性冠脉综合征;药物治疗组2例死亡,9例发生脑卒中,4例发生急性冠脉综合征。两组患者术后近期死亡率和冠脉缺血事件发生率无统计学差异(P>0.05);介入治疗组脑卒中发生率低于药物治疗组(P<0.05)。术后远期随访:介入治疗组5例死亡,5例出现脑卒中,7例出现冠脉缺血;药物治疗组6例死亡,14例出现脑卒中,10例出现冠脉缺血。两组远期死亡率和冠脉缺血发生率差异无统计学意义(P>0.05);介入治疗组脑卒中发生率低于药物治疗组(P<0.05)。两组5年生存率(94.49%vs 92.38%)差异无统计学意义(P>0.05)。结论:经皮颈动脉支架植入术治疗颈动脉狭窄可明显改善患者近、远期脑卒中发生率,而未能明显减少冠脉缺血事件的发生,远期生存率亦无明显差异。     

支架置入术治疗颈动脉狭窄的临床研究

目的 观察颈动脉支架植入治疗颈动脉狭窄的疗效及其安全性。方法 72例颈动脉狭窄患者进行了经皮腔内血管成形和支架植入术治疗。结果 所有患者均经DSA血管造影汪实有颈内动脉狭窄，手术成功率100％，治疗后残余狭窄率均低于30％：72例患者中有2例出现可逆性小卒中；3例出现术中球囊扩张时对侧肢体局灶性癫痫发作；3例血管痉挛；25例出现低血压、心动过缓；1例出现术后高灌注综合征；5例出现其它部位出血。结论 血管内支架成形术是一种治疗颈动脉狭窄安全有效的方法，提高术者操作技巧及围手术期监护可以降低手术并发症和死亡率，提高安全性。     

血管内支架置入术治疗冠心病合并肾动脉狭窄22例临床分析

目的：研究分析血管内支架置入术用于冠心病合并肾动脉狭窄的治疗效果。方法择取我院在2013年6月~2014年6月接收治疗的冠心病合并肾动脉狭窄的22例患者,均采用血管内支架植入术进行治疗。结果本组22例患者共置入冠状动脉支架26枚,置入肾动脉支架者22例,全部患者手术成功,且术后没有并发症。术后随访3个月,18例高血压患者中,11例血压恢复正常水平,7例应用降压药物的剂量下降,1例没有变化。6例肾功能不全患者体内血肌酐含量显著减少,其中2例患者血肌酐含量恢复正常水平。结论血管内支架置入术用于冠心病合并肾动脉狭窄的治疗具有安全性高、疗效性好等优点,适用于临床治疗。     

血管内支架治疗鼻咽癌放疗后颈部血管狭窄或闭塞病变的效果

目的探讨血管内支架置入术治疗鼻咽癌放疗后的颈动脉狭窄或闭塞病变的疗效。方法对3例鼻咽癌患者放疗后出现严重动脉狭窄或闭塞病变的颈部血管行球囊成形术及支架置入术并进行随访。结果 3例患者均为男性,其中1例为双侧颈动脉闭塞,进行了一侧颈动脉闭塞病变再通术;1例为双侧颈动脉重度狭窄,进行了左侧颈动脉支架成形术;1例右颈内动脉起始段严重狭窄,左侧颈动脉闭塞,对右侧颈动脉严重狭窄处进行了血管内支架治疗;经过随访并未发现有支架内再狭窄。结论血管内支架置入术是治疗鼻咽癌放疗后颈部血管重度狭窄或闭塞病变的有效手段。     

彩色多普勒超声对颈动脉狭窄支架成形术疗效及术后残余狭窄的评估价值

目的:探讨彩色多普勒超声对颈动脉狭窄支架成形术(carotid artery stenting,CAS)患者疗效及术后残余狭窄的评估价值.方法:前瞻性选取2018年1月至2020年9月在池州市人民医院神经外科治疗的110例CAS患者,对比手术前后超声相关测量指标.依据数字减影血管造影(digital subtracti...     

内支架在气道狭窄中的临床应用

目的探讨内支架在气道狭窄中临床应用的价值。方法对51例大气道狭窄患者在透视下，其中经口16例，经鼻35例，应用支架放置器将镍钛舍金支架放入狭窄的大气道。结果所有病例均一次性放置成功，放置气管支架32例，支气管支架10例，气管、支气管均放置支架9例。术后患者气促症状明显改善。结论镍钛合金支架治疗大气道狭窄是一种有效、安全的方法。     

颈动脉狭窄支架植入术后并发高灌注综合征的护理

目的：探讨颈动脉狭窄支架植入术后并发症高灌注综合症临床特点及护理。方法回顾性分析50例颈动脉狭窄支架植入术后发生5例高灌注综合症,指出术前评估患者是否有高灌注危险因素,确保脑灌注积极完善术前各项准备工作,针对性进行心理护理及健康教育,术中,术后加强病情观察,密切观察患者神志,瞳孔,生命体征等观察,耐心倾听患者主诉,保持血压稳定,特别注意预防脑出血,术后加强监护及其它术后饮食护理,患者舒适体位护理,严密观察生命体征监测及对症护理,能有效预防和护理高灌注综合症。结果50例患者成功植入支架,5例发生高灌注综合症,其中2例并发出现脑出血,2例并发出现脑水肿,1例无明显变化。结论高灌注综合症是可预测和预防的。     

Percutaneous transluminal angioplasty with stenting in extended supra-aortic artery dissection

A 51-year-old man underwent two percutaneous transluminal angioplasties with stenting for a dissection that extended from the right brachiocephalic trunk into the proximal part of the internal carotid artery. The patient presented with transient dysphasia one month after surgical treatment of a type A dissecting aortic aneurysm. Initially, he was managed with conservative treatment, with no effect on the dissected arteries. Two stents were then successfully placed over the site of dissection to prevent further embolization. At follow-up 29 months after stent implantation, the patient was asymptomatic and ultrasound examination demonstrated no recurrence of dissection at the stented segment. This case suggests that stenting could be a successful treatment of cervical artery dissection.     

Comparison of mid-term outcomes of carotid artery stenting for moderate versus critical stenosis

Introduction

Little is known about the prognosis of moderate versus critical carotid stenosis treated by carotid artery stenting (CAS).

Material and methods

This was a retrospective analysis of a single-centre registry including 271 consecutive patients (69 ±9 years, 87% at high risk for surgery), in whom 308 procedures were performed. The study included both symptomatic (≥ 50% carotid artery stenosis) and asymptomatic (≥ 70% carotid artery stenosis) patients. The primary endpoint was the rate of adverse events during follow-up (range 1-48 months), defined as all-cause death or stroke.

Results

We treated 115 critical and 193 moderate stenoses and implanted 318 stents (56% with closed cell design). Embolic protection systems were used in 296 cases (96%). The technical success rate was 98.2% in the critical stenoses group and 99% in the moderate group (NS). During follow-up, the incidence of the primary endpoint was 12.9% (13 pts) in the critical stenoses group and 14.7% (25 pts) in the moderate stenoses group (estimated 3-year freedom from death/stroke was 0.844 vs. 0.812; log-rank test p = 0.983). Left ventricular ejection fraction < 40%, significant contralateral carotid artery occlusion or stenosis and renal insufficiency were identified as significant predictors of the primary endpoint (p < 0.03).

Conclusions

Carotid artery stenting with embolic protection systems in patients at high risk for carotid endarterectomy is safe. Patients with initially moderate and critical stenoses have an identical mid-term prognosis with regard to death and stroke.     

Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

OBJECTIVES:

A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting.

MATERIALS AND METHOD:

Twenty‐nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end‐diastolic velocity, cm/s) were measured 24 hours after the procedures and also at 12 months post‐procedure. Residual stenoses (immediately post‐procedure) and restenoses (within 12 months of procedure) were defined as narrowings of ≥50% on duplex ultrasound examination.

RESULTS:

In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24‐hour and 12‐month post‐procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis) were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34%) and the patch closure group (1 case, 1.53%, P  =  0.08). At 12 months, 2 stenting patients (6.88%) and 2 patch closure patients (3.07%) had ≥50% restenosis (P  =  0.58). One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention.

CONCLUSION:

Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or patched carotids.     

Outcomes of carotid artery stenting at a high-volume Brazilian interventional neuroradiology center

OBJECTIVES:

Carotid artery stenting is an emerging revascularization alternative to carotid endarterectomy. However, guidelines have recommended carotid artery stenting only if the rate of periprocedural stroke or death is < 6% among symptomatic patients and < 3% among asymptomatic patients. The aim of this study is to evaluate and compare clinical outcomes of symptomatic and asymptomatic patients who had undergone carotid artery stenting as a first-intention treatment.

METHOD:

A retrospective analysis of patients who underwent carotid artery stenting by our interventional neuroradiology team was conducted. Patients were divided into two groups: symptomatic and asymptomatic patients. The primary endpoints were ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage and major adverse cardiac and cerebrovascular events at 30 days. The secondary endpoints included ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage, ipsilateral transient ischemic attack and major adverse cardiac and cerebrovascular events between the 1- and 12-month follow-ups.

RESULTS:

A total of 200 consecutive patients were evaluated. The primary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral stroke (2.4% vs. 2.7%, p = 1.00), ipsilateral parenchymal hemorrhage (0.8% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (4.7% vs. 2.7%, p = 0.71). The secondary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral ischemic stroke (0.0% vs. 0.0%), ipsilateral parenchymal hemorrhage (0.0% vs. 0.0%), ipsilateral TIA (0.0% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (11.2% vs. 4.1%, p = 0.11).

CONCLUSIONS:

In this retrospective study, carotid artery stenting was similarly safe and effective when performed as a first-intention treatment in both symptomatic and asymptomatic patients. The study results comply with the safety requirements from current recommendations to perform carotid artery stenting as an alternative treatment to carotid endarterectomy.     

症状性颈动脉粥样硬化性狭窄患者经颅电刺激运动诱发电位的研究

目的：探讨经颅电刺激运动诱发电位(MEP)对症状性颈动脉粥样硬化性狭窄的诊断价值。方法：对32例颈动脉粥样硬化狭窄患者和20例正常人行经颅电刺激MEP检查,评价狭窄程度与MEP的关系。结果：症状性颈动脉粥样硬化患者电刺激狭窄侧大脑皮层手区与对侧上肢记录MEP的潜伏期和中枢传导时间(CMCT)较正常对照组和健侧延长(P＜0．05)；对侧下肢CMCT较正常对照组和健侧延长(P＜0．05)。结论：MEP异常程度与临床病情轻重和病变部位密切相关,提示MEP能客观反映颈动脉狭窄患者中枢运动传导通路亚临床受损的情况,具有定量的价值。     

P300潜伏期在无症状颈动脉狭窄患者认知障碍评估中的应用

目的:探讨无症状颈动脉狭窄(ACS)对认知功能的影响,分析P300潜伏期与认知障碍的相关性。方法:前瞻性研究。纳入2018年10月—2020年1月蚌埠市第三人民医院神经内科120例ACS患者为狭窄组,选择年龄与之相匹配的同期正常体检者50例为对照组。对比两组受试者年龄、性别、受教育年限,吸烟史、饮酒史以及高血压、糖尿病...     

缺血性脑卒中患者颈动脉狭窄程度与同型半胱氨酸相关性分析

目的 研究缺血性脑卒中患者同型半胱氨酸(Hcy)水平的变化,以探讨Hcy水平与颈动脉狭窄程度的相关性.方法 选取颈动脉狭窄的缺血性脑卒中患者130例,依据彩色多普勒超声检测颈动脉狭窄程度的结果将其分为4组:轻度狭窄组(32例)、中度狭窄组(35例)、重度狭窄组(33例)、闭塞组(30例).选择同期在本院的健康成年人30例为对照组.分别测定各组血浆Hcy、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)水平,并进行比较.结果 缺血性脑卒中组各组与对照组TC、TG、LDL水平比较,差异均无统计学意义(P＞0.05),而血浆Hcy水平则明显高于对照组,差异有统计学意义(P＜0.05).对照组、轻度狭窄组、中度狭窄组、重度狭窄组、闭塞组血浆Hcy水平依次升高,各组间比较差异均具有统计学意义(P＜0.05).血浆Hcy水平与颈动脉狭窄程度之间呈正相关(r=0.835,P＜0.05),但与TC、TG、LDL水平无相关(r分别为0.031、0.012、0.018,P＞0.05).结论 Hcy与颈动脉狭窄程度有密切相关性,Hcy为缺血性脑卒中发病的危险因素.     

颈内动脉颅外段狭窄支架成形术与内科保守治疗的疗效比较

目的比较血管内支架成形术与内科保守治疗对颈内动脉颅外段狭窄的疗效。方法符合人选标准的100例颈内动脉颅外段狭窄的患者．根据自愿与经济承受能力,分为支架成形术（SAA）组36例,其中男性28例,女性8例,年龄46～69岁．平均年龄57.5岁。内科保守治疗组64例。其中男性46例,女性18例,年龄48～65岁,平均年龄58．5岁。SAA组采用支架成形术．并口服拜阿斯匹林。内科保守治疗组采用抗凝、抗血小板、口服他汀类药物。每3个月随访1次。随访6～24个月,平均15个月。记录①卒中复发率、病死率;②NIHSS评分。结果SAA组有2例（5．56％）发生狭窄动脉区的轻微卒中,NIHSS评分小于4分,死亡1例（2．78％）。内科保守治疗组12例（18．75％）再发卒中,死亡2例（3．13％）,NIHSS评分2—4分7例．10分以上5例。两组比较．内科保守治疗组再发卒中率高（P〈0．01）。NIHSS评分,SAA组预后优于内科保守治疗组。结论血管内支架成形术治疗颈内动脉颅外段粥样硬化性狭窄是安全有效的,其疗效优于内科保守治疗。     

Carotid artery stenosis and tachyarrhythmias: regional cerebral blood flow during high-rate ventricular pacing after one vessel occlusion in rats

The aim of the present study was to investigate the effect of hypotensive tachycardias on cerebral blood flow (CBF) in the presence of significant carotid stenosis. The experiments were performed in 57 spontaneously breathing rats during arterial normoxia and normocapnia anesthetized with thiobarbital. CBF was determined with radio-labeled microspheres during control conditions (normofrequent sinus rhythm, normotension; group A; n = 15), during high-rate left ventricular pacing (660–840 ppm) at normotension (group B₁; n = 13), borderline hypotension (group B₂; n = 15) and severe hypotension (group B₃; n = 7). In addition, CBF measurements were performed during borderline hypotension induced by hemorrhage (group C; n = 7). Global CBF was 1.09 ± 0.29 ml g^–1 min^–1 in group A, 0.93 ± 0.40 in group B₁, 0.68 ± 0.31 in group B₂ (P < 0.05 vs. A), 0.42 ± 0.16 in group B₃ (P < 0.05 vs. A) and 0.83 ± 0.2 in group C. The highest CBF values were found in the cerebellum (A; 1.43 ± 0.5 ml g^–1 min^–) and the lowest in the postocclusive tissue of the ipsilateral hemisphere (A; 0.74 ± 0.2 ml g^–1 min^–1). In all groups a 15% mean CBF reduction in the right hemispherical cerebrum in comparison to the left hemisphere was observed (P < 0.01). In contrast, hemispherical CBF of the cerebellum did not differ. The CBF blood pressure relationship shifted to lower CBF values, the threshold of CBF regulation shifted to higher blood pressure values in the tissue regions distal to the occluded vessel during hypotensive tachycardias. One carotid artery occlusion and high rate ventricular pacing seem to be a reliable model for quantifying cerebral hemodynamics during arrhythmias in the presence of carotid stenoses. Using this experimental approach it was demonstrated that hypotensive tachycardias and obstructions within the ectracranial carotid vascular bed such as arterial vessel stenoses and occlusions have an additive effect on CBF reduction.Abbreviations CBF cerebral blood flow - P_m mean arterial blood pressure Correspondence to: A. Hagendorff     

Percutaneous transluminal coronary angioplasty - Histopathological analysis of nine necropsy cases

Summary From 1982 to 1984 nine of 300 patients undergoing transluminal coronary angioplasty died. The nine coronary arteries and one saphenous aorto-coronary by-pass graft affected by angioplasty were studied by light microscopy. The following types of lesions were found, frequently in association: rupture of the plaque, circumscribed or reaching to the intimal layer or extending beyond it, dissections (fissures) between arterial layers, intra-plaque haemorrhage, plaque emboli and thrombosis. In two cases the therapeutic approach was considered to be clinically and pathologically successful; the patients survived 24 h (case 6) and forty days (case 4). Case 6 which presented recent lesions indicative of success showed, in contrast with the other non-successful cases, rupture affecting not only the initimal layer but also deeper structures of the arterial wall. There were also more extensive fissures. Case 4 which presented late alterations indicative of success showed a plaque fracture whose borders were kept apart by fibrous tissue. In conclusion, we believe that angioplasty allows the re-establishment of arterial blood flow by provoking deep intimal and medial rupture producing a small fissure between the arterial layers and a widening of the lumen; in cases with good late results these alterations cicatrize leaving a wider arterial lumen.