血管内支架成形术治疗锁骨下动脉狭窄性疾病55例临床观察

目的探讨锁骨下动脉狭窄或闭塞性疾病的介入治疗疗效。方法回顾分析55例锁骨下动脉狭窄或闭塞病变行血管内支架治疗的临床资料。结果 46例锁骨下动脉狭窄病变(狭窄率>70%)成功置入支架,9例闭塞锁骨下动脉中8例成功置入支架。46例经股动脉置入支架,8例经肱动脉逆行置入支架。锁骨下动脉支架成功置入后肱动脉及桡动脉搏动良好,伴有盗血现象的13例患者症状消失。随访发现5例锁骨下动脉支架置入后9～12个月再狭窄,后再置入5枚支架,血管开通良好。结论应用血管内支架治疗锁骨下动脉狭窄或闭塞是一种微创、安全、有效的治疗方法。     

锁骨下动脉狭窄的经皮血管球囊成形术及内支架治疗

目的 评价并比较经皮血管球囊成形术及内支架治疗对动脉粥样硬化及大动脉炎所致锁骨下动脉狭窄梗阻性病变的治疗效果。方法 １３例锁骨下动脉狭窄梗阻性病变患者,病因为动脉粥样硬化７例,大动脉炎６例。其中锁骨下动脉狭窄８例,完全闭塞５例,均实施了介入治疗。６例单纯行经皮血管球囊成形术,６例置入血管内支架,１例介入治疗失败。结果 １２例行经皮血管内成形术（ＰＴＡ）或血管内支架置入治疗获成功,６例分别置入Ｓｔｒ     

锁骨下动脉狭窄患者血管内支架置入术的护理

目的：总结锁骨下动脉支架置入术治疗锁骨下动脉狭窄患者的护理经验。方法：选择我科2005—2006年锁骨下动脉支架置入术患者2例。全部采用经股动脉穿刺插管行造影显示有血管狭窄行锁骨下动脉支架置入术。结果：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的发生，患者主动配合治疗是手术成功的关键。     

锁骨下动脉狭窄或闭塞支架治疗中期疗效评价

目的 评价血管支架治疗锁骨下动脉狭窄或闭塞的中期临床疗效.方法 经彩超、CTA明确诊断的31例锁骨下动脉狭窄或闭塞患者,其中狭窄18例(19条),闭塞13例(13条).导丝开通病变血管后置入支架.术后问诊及彩色多普勒超声进行随访.结果 除4例闭塞血管开通失败外,27例共计28条病变动脉共成功置入28枚支架.术后患者症状、体征均明显改善.术前有锁骨下动脉窃血征象14例,术后12例消失.27例随访6～62个月(平均24.0个月±16.5个月).术后3例患者再狭窄:1例发生于术后9个月,经PTA后随访12个月血管开放良好;1例术后10个月,PTA后随访8个月开放良好;1例术后12个月再狭窄,转为外科搭桥手术.1例大动脉炎术后8个月死于脑出血;1例术后14个月死于脑梗死.余均无症状、体征再发,多普勒超声提示血管通畅.结论 血管支架可安全、有效治疗锁骨下动脉狭窄/闭塞并有良好中期疗效.     

双入路血管内支架成形治疗锁骨下动脉盗血综合征

目的 探讨双入路血管腔内成形术治疗锁骨下动脉盗血综合征的疗效.方法 采用经肱动脉和股动脉双入路交换导丝贯通行血管内支架成形治疗7例左锁骨下动脉闭塞(狭窄).结果 双入路血管内支架成形治疗锁骨下动脉闭塞患者,手术成功率高,7例左锁骨下动脉血流完全通畅、椎动脉血流方向恢复.局部并发症少.结论 双入路血管内支架成形术对于锁骨下动脉闭塞患者效果可靠,操作相对简单、安全,并发症少.     

经皮穿刺锁骨下动脉腔内成形术

目的：评价经皮穿刺锁骨下动脉腔内成形术的效果及安全性。方法：对76例锁骨下动脉严重狭窄或完全闭塞的患者行经皮经腔血管成形术（PTA）。所有患者均有椎基底动脉和（或）上肢动脉供血不足症状。术前DSA证实锁骨下动脉狭窄69例,完全闭塞7例。行单纯球囊扩张术68例,置入支架8例。结果：PTA术后所有患者症状均消失或明显减轻。DSA、经颅多普勒超声（TCD）显示45例患者锁骨下动脉窃血被纠正,有3例出现并发症（2例穿刺部位假性动脉瘤形成,1例术中一过性眩晕暧间恢复）。经4-35个月的随访（平均29个月）,发生再狭窄3例。结论：PTA治疗锁骨下动脉严重狭窄或完全闭塞是有效和安全的,并发症低于手术治疗。     

经皮单一支架治疗椎动脉、锁骨下动脉分叉部串联狭窄

目的 初步评价经皮单一支架治疗椎动脉、锁骨下动脉分叉部串联狭窄的疗效及安全性.方法 2009年2月至2010年4月对7例椎动脉、锁骨下动脉分叉部串联狭窄患者,在置入脑保护装置下进行了经皮单一支架治疗椎动脉、锁骨下动脉分叉部2处狭窄.所有患者均作定期随访,以临床症状、多普勒超声评估治疗效果并观察有无再狭窄.结果 本组7例...     

症状性锁骨下动脉狭窄和闭塞的介入治疗

目的评价症状性锁骨下动脉狭窄和闭塞介入治疗方法。方法32例锁骨下动脉狭窄和闭塞,其中锁骨下动脉狭窄19例,闭塞13例。27例有上肢缺血,7例伴头部缺血。应用导丝开通,PTA及内支架置入方法进行治疗。结果28例开通成功。术中发生脑梗死1例。单纯PTA治疗3例,1例上肢缺血症状部分好转。24例置入内支架后症状、体征明显改善。18例有锁骨下动脉窃血征象,术后16例消失。27例随访2～80个月,平均(29.5±21.0)个月。术后9个月闭塞2例,1例PTA后再获通畅。术后12个月闭塞1例,改行外科手术治疗。1例大动脉炎于术后9个月死于心功能衰竭。余在随访期内均无症状再发,超声Dopplor检查均通畅。结论介入方法可有效治疗症状性锁骨下动脉狭窄、闭塞。     

球囊导管血管成形术治疗锁骨下动脉狭窄

经皮经腔球囊导管成形术治疗11例锁骨下动脉狭窄。11例有13处狭窄病变,PTA 成功9例,其中7例的狭窄消失或明显改善,2例减轻。血压由PTA 前的平均11.12/7.02kPa 升高至PTA后的16.88/10.48kPa。临床症状消失或减轻。PTA 成功的9例随访1～12月(平均5.9月)。除1例1年狭窄复发外,其余均无症状。本组无并发症.     

双向内膜下技术在锁骨下动脉闭塞血管内治疗中的应用北大核心CSCD

目的探讨锁骨下动脉闭塞血管内治疗中导丝无法回入真腔时应用双向内膜下技术——顺逆行内膜下动脉成形术(SAFARI)提高治疗成功率的可行性及安全性。方法回顾性分析2013年8月至2016年6月收治的11例症状性锁骨下动脉闭塞患者临床资料,其中男8例,女3例,平均年龄67(61~74)岁,均于开通闭塞血管失败后通过SAFARI技术重建锁骨下动脉。结果 10例患者通过SAFARI技术实现了锁骨下动脉再通并一期植入支架(平均长度46.4 mm),1例失败,技术成功率为90.9%。术后未发生严重并发症。电话随访6~36个月,未发现支架内再狭窄。结论 SAFARI技术治疗钙化严重、阻塞较长的锁骨下动脉闭塞安全有效,可进一步提高血管内治疗成功率。     

Successful percutaneous transluminal angioplasty and stenting for symptomatic intracranial vertebral artery stenosis using intravascular ultrasound virtual histology

This is the first report of percutaneous transluminal angioplasty (PTA) of an intracranial artery applying intravascular ultrasound virtual histology (IVUS-VH), which has been recently developed for tissue characterization of coronary artery plaque. We report a case of successful PTA and stenting for symptomatic intracranial vertebral artery stenosis using IVUS-VH.     

外科高危颈动脉狭窄的直接内支架成形术

目的　探讨对外科高危的症状性颈动脉狭窄患者采用直接内支架成形术治疗的安全性及并发症。方法　对 9例 (11支血管 )外科高危的症状性颈动脉狭窄进行了内支架成形术治疗 ,随访 1～ 5个月 (平均 3个月 ) ,观察术中及术后并发症。结果　 9例 (11支血管 )的内支架植入手术成功率为10 0 %。术中及术后随访 ,支架开通良好 ,无短暂性脑缺血发作 (TIA)及卒中发生 ,脑缺血症状消失 ,无围手术期严重并发症。结论　直接内支架成形术治疗高危症状性颈动脉狭窄是一种可以采用的治疗方法 ,但还需进一步临床积累     

Vertebral artery origin stenting with buddy wire technique in tortuous subclavian artery

Catheterization of vessels with severe tortuosity and atherosclerotic changes may represent a technical challenge and is associated with a higher incidence of vascular complications [Putman CM, Chaloupka JC. Use of large-caliber coronary guiding catheters for neurointerventional applications. AJNR Am J Neuroradiol 1996;17:697-704]. Placement of guiding catheter to the tortuous subclavian artery in vertebral artery origin stenting procedure is such a condition with difficulties. In the presence of severe tortuosity of aortic arch and proximal subclavian artery placement of guiding catheter may be difficult and yield poor backup support. We describe a technique that uses a buddy wire to make the guiding catheter stable in its proper position and make possible to perform stenting the vertebral artery origin stenosis.     

颈动脉狭窄或闭塞患者数字记忆的功能磁共振成像研究

目的:探讨左侧颈内动脉/大脑中动脉狭窄和闭塞患者与正常人数字工作记忆的激活脑区差异及其记忆障碍的脑加工机制。方法:对12例左侧颈动脉狭窄/闭塞患者(其中左侧颈内动脉狭窄4例,左侧颈内动脉闭塞2例,左侧大脑中动脉狭窄5例,左侧大脑中动脉闭塞1例,24例正常对照组进行数字记忆任务的功能磁共振成像,采用AFNI软件进行数据分析和脑功能区活动图像。结果:左侧颈内动脉/大脑中动脉狭窄和闭塞患者的反应时间较对照组显著延长(P0.05),正确率较对照组明显降低(P0.05)。脑激活图显示数字工作记忆的编码期、保持期、提取期患者组的脑激活明显少于正常对照组,而且脑激活的左侧半球优势减弱,右侧半球出现代偿性激活,其中提取期最为明显。结论:左侧颈动脉狭窄/闭塞患者数字记忆任务的脑激活区存在损害,功能磁共振成像研究能为早期诊断认知障碍提供影像学依据。     

颈内动脉急性闭塞的溶栓及支架置入治疗

目的：探讨颈内动脉急性闭塞的溶栓及支架置入治疗的有效性及安全性。方法：对6例颈内动脉急性闭塞的患者行动脉内溶栓治疗,其后对残余狭窄行支架置入治疗。溶栓前及治疗后24 h 进行神经功能缺损评分,同时观察脑内及其他系统有无出血并发症,并观察肢体活动及意识改善情况。结果：6例患者颈内动脉完全再通,血流量恢复,临床症状改善迅速,24h后4例瘫痪肢体肌力提高3级,2例提高2级。结论：颈内动脉急性闭塞患者的溶栓及支架置入治疗的疗效是值得肯定的。治疗时间越早疗效越好,安全性越高。     

上腔静脉及其主要属支静脉狭窄或闭塞介入治疗的研究

目的 探讨上腔静脉及其主要属支静脉狭窄或闭塞的介入治疗方法和疗效.方法 搜集2000年10月至2010年10月期间因上腔静脉及其主要属支狭窄或闭塞接受介入治疗的患者60例,男38例、女22例,年龄15～72岁,平均(58±4)岁.17例患者给予单纯球囊扩张,43例给予球囊扩张加支架置入术.治疗前后测量梗阻流入侧血管内压力,结果的比较用配对t检验.结果 60例患者血管成形后,梗阻流入侧测得静脉压力在狭窄开通前为(24.8±2.3)mm Hg(1 mm Hg=0.133 kPa),开通后为(7.1±1.5)mm Hg,差异有统计学意义(t=3.232,P＜0.01);临床症状完全缓解27例,部分缓解28例,无效5例;无严重并发症发生.随访6个月,出现再狭窄10例,经再次介入后再通6例,4例转外科手术.结论 对上腔静脉及其属支静脉狭窄或闭塞行介入治疗可以迅速解除梗阻,恢复血流通畅,降低梗阻远端静脉的压力,缓解临床症状.

Abstract：

Objective To assess the different methods and their outcomes of interventional therapy for stenosis or occlusion in superior vena cava and its branches. Methods Sixty patients with stenosis or occlusion of SVC and its branches were retrospectively analyzed after interventional therapy. Among them, 38 were males and 22 were females, with age range from 15 to 72 years old(mean age 58). Seventeen patients were treated by thrombolysis, and the rest 43 patients accepted percutaneous angioplasty and stenting. Before and after that, the pressures within the vein were measured at the inflow side. The paired-t test was used for statistical analysis. Results After treatment, the pressure at the inflow side dropped from (24.8±2.3)mm Hg to (7.1±1.5)mm Hg(1 mm Hg=0.133 kPa), with a significant difference(t=3.232,P＜0.01). The clinical outcomes included complete relief in 27 patients, partial relief in 28 patients and non-relief in 5 patients. No major complications occurred. During 6 months follow up, restenosis occurred in 10 patients, among whom 6 received repeat intervention with good results. The other 4 patients turned to surgery .Conclusion Interventional therapy for stenosis or occlusion in SVC and its branches could recanalize the vessels, restore the blood flow and relief the clinical symptoms.     

Percutaneous transluminal angioplasty of subclavian stenosis to improve inflow to internal mammary coronary arterial grafts

Two cases are described of patients who previously had undergone myocardial revascularization with left internal mammary arterial (LIMA) grafts, who presented with recurrent cardiac symptoms and clinical evidence of left subclavian stenosis. Arteriography revealed significant subclavian stenosis with poor or absent filling of the LIMA grafts in both cases. Following successful percutaneous transfemoral angioplasty (PTA) of the lesions, there was improved flow in both LIMA grafts, with symptomatic improvement in both patients. There has been no evidence of re-stenosis at follow-up (2 and 5 years). Although rare, a promixal subclavian stenosis should be considered as a cause of recurrent symptoms in patients with previous LIMA grafts, causing a coronary Subclavian Steal syndrome. Precutaneous transfemoral angioplasty is a safe and effective treatment that can improve inflow through the graft. Correspondence to: F. Wallis     

主动脉缩窄伴右锁骨下动脉闭塞一例

患者女,13岁.因发现心脏杂音10余年,伴右下肢活动障碍6年余入院.查体:左上肢BP 210/101 mmHg,右上肢BP 191/83 mmHg,左下肢BP 125/80 mmHg,右下肢BP119/78 mmHg.一般情况尚可,心尖搏动增强,胸骨左缘2～3肋间闻及Ⅲ级连续性机械样杂音,主动脉听诊区闻及Ⅲ级收缩期杂音,心率84次/min,率齐.周围血管征(-),右侧桡动脉搏动弱.脊柱侧弯畸形,右足高弓马蹄内翻,右下肢较左下肢缩短3 cm,跛行.双侧股动脉、足背动脉未触及,双下肢无浮肿,巴彬斯基征( ),右踝阵挛( ),双侧膝反射轻度亢进.下肢血气检查示:PO2 50.4 mmHg,SaO2 85.8%,右上肢SaO289.4%,左上肢PO2 81.4 mmHg,SaO2 96.2%.心脏超声检查诊断为先天性心脏病,主动脉弓离断,动脉导管未闭.     

Carotid artery stenting for stenosis with intraluminal thrombus

Since intraluminal thrombus in the context of carotid artery stenosis is rarely encountered, treatment for this condition remains controversial. The present paper describes six cases of carotid artery stenosis with thrombus and discusses the efficacy and complications of carotid artery stenting (CAS). From April 2002 to May 2004, six patients with carotid artery stenosis and intraluminal thrombus receiving medical therapy underwent CAS at our institution. CAS was performed with distal protection alone (method 1) in three patients, and three other patients underwent CAS with reversed-flow system and distal protection (method 2). Two of six patients experienced worsening neurologic symptoms despite medical therapy. All six patients were successfully treated with CAS and showed satisfactory patency of the artery. Embolic lesions were detected on diffusion-weighted MRI after the procedure in all patients treated with method 1 but not in patients treated with method 2. Complications included stent thrombosis (n=1) and in-stent thrombus (n=1). All six patients achieved a modified Rankin Scale 1 or 2 classification at 30 days after stenting. In conclusion, CAS was feasible for stenosis even with intraluminal thrombus. Use of method 2 for this condition may reduce the incidence of thromboembolic events although our series was small in number.