颈动脉支架成形术治疗老年重度颈内动脉狭窄患者的疗效观察

目的评价脑保护装置下老年重度颈动脉狭窄患者颈动脉支架成形术的有效性及安全性。方法选择年龄≥70岁的重度症状性颈动脉狭窄患者43例,均行颈动脉支架成形术,术中均应用脑保护装置,观察术后狭窄改善情况,围术期并发症的发生情况以及回收的脑保护装置内脱落栓子情况,对患者随访1年。结果在43例患者中,脑保护装置及颈动脉支架均放置到位,术后残余狭窄率均<30%,患者颈动脉平均狭窄程度从(82.8±6.5)%降低至(12.4±5.9)%,支架置入手术前后比较,差异有统计学意义(P<0.05)。回收的脑保护装置中,发现27个有脱落的组织碎片,患者术后缺血相关症状均有明显改善,围术期所有患者均未出现症状性脑卒中,无手术相关死亡事件发生,1年随访无缺血性脑血管事件发生,颈动脉超声复查未见支架内发生再狭窄。结论脑保护装置下,对老年重度颈内动脉狭窄患者行颈动脉支架成形术安全、有效。     

脑保护装置下的血管成形和支架置入术治疗颈动脉狭窄

目的探讨颈动脉狭窄患者颈动脉血管成形和支架置入术(CAS)中应用脑保护装置的有效性和安全性。方法颈动脉狭窄患者CAS治疗时,12例应用脑保护装置(滤网型),16例未使用脑保护装置。结果28例颈动脉狭窄患者成功释放31枚自膨式支架。未使用脑保护装置组球囊预扩1次(6·2%),无一例后扩;使用脑保护装置组球囊预扩4次(33·3%),后扩6次(50%)。CAS治疗中,7例(25·0%)患者出现短暂性心率减慢和低血压。回收的脑保护装置中2例(16·7%)肉眼可见组织碎片。使用脑保护装置组在围手术期和随访期无神经并发症;未使用脑保护装置组围手术期发生1例(6·3%)脑梗死,随访期发生1例(6·3%)脑梗死。结论脑保护装置的使用有助于减少颈动脉狭窄患者CAS治疗的神经并发症。     

颅外颈动脉支架成形术后颈动脉狭窄的危险因素分析

目的探讨颈动脉支架形成术(CAS)治疗颈动脉狭窄的危险因素,并分析其有效性和安全性。方法回顾性分析采用CAS治疗颈动脉狭窄的110例病人资料,根据术后30 d内有无不良事件发生分为有不良事件组(24例)和无不良事件组(86例),比较两组病人临床资料、危险因素、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前血管狭窄程度、狭窄部位等,预后结果采取多因素Logistic回归分析,全部CAS病例应用脑保护装置防止血栓脱落。结果 110例病人共植入支架115枚,脑保护装置全部回收,支架植入术成功率为100%。狭窄程度由术前中度、重度变为术后轻度、中度;围术期术后总体并发症24例(21.8%),30 d内不良事件7例(6.36%);随访3个月后,2例支架内再狭窄。两组年龄、高血压比较差异有统计学意义(P0.05);多因素Logistic回归分析显示高血压是CAS治疗颈动脉狭窄的危险因素。结论 CAS治疗颈动脉狭窄30 d内出现不良事件与高血压显著相关,颅外CAS可有效减轻病人颈动脉狭窄程度,且围术期是相对安全的。     

脑保护装置下颈动脉狭窄支架成形术临床应用观察

目的观察脑保护装置下颈动脉狭窄支架成形术的有效性和安全性。方法颈动脉狭窄患者45例,在颈动脉狭窄支架成形术中使用脑保护装置,首先将脑保护装置(过滤伞)小心通过颈动脉狭窄部位放置于颈动脉狭窄的远端并释放,然后再行颈动脉狭窄支架成形术,观察手术期缺血性脑血管病事件及其他并发症的发生情况。结果 45例保护伞放置及支架成形术均成功,术后残余狭窄<20%。操作过程中未发生栓塞等并发症。结论脑保护装置能有效提高颈动脉狭窄支架成形术的安全性,可降低手术风险。     

脑保护装置下的血管成形和支架置入术治疗颈动脉狭窄

目的：探讨颈动脉狭窄患者颈动脉血管成形和支架置入术（CAS）中应用脑保护装置的有效性和安全性。方法：颈动脉狭窄患者CAS治疗时，12例应用脑保护装置（滤网型），16例未使用脑保护装置。结果：28例颈动脉狭窄患者成功释放31枚自膨式支架。未使用脑保护装置组球囊预扩1次（6．2％），无一例后扩；使用脑保护装置组球囊预扩4次（33．3％），后扩6次（50％）。CAS治疗中，7例（25．0％）患者出现短暂性心率减慢和低血压。回收的脑保护装置中2例（16．7％）肉眼可见组织碎片。使用脑保护装置组在围手术期和随访期无神经并发症；未使用脑保护装置组围手术期发生1例（6．3％）脑梗死，随访期发生1例（6．3％）脑梗死。结论：脑保护装置的使用有助于减少颈动脉狭窄患者CAS治疗的神经并发症。     

远端保护装置下CAS治疗颈动脉狭窄的疗效及并发症分析

目的探讨在远端保护装置（保护装置）下采用血管内支架成形术（CAS）治疗颈动脉狭窄的疗效,分析其并发症发生情况。方法对47例颈动脉狭窄患者行颈动脉CAS时应用保护装置,先将保护装置通过狭窄部位并在狭窄远端展开,然后行保护性颈动脉CAS;并对手术过程、疗效及围术期并发症进行分析。结果术后颈动脉造影证实,残余狭窄率〈30%,术后第10天死亡1例;术后1 a均未发生TIA、再卒中及死亡。结论在保护装置下采用CAS治疗颈动脉狭窄安全有效;掌握其适应证及操作规范,可减少并发症发生。     

远端保护装置用于重度颈动脉狭窄的介入治疗

目的分析远端保护装置应用于颈动脉狭窄支架成形术的安全性和有效性。方法对26例症状性颈动脉狭窄患者行血管内支架成形术时应用远端保护装置，首先将远端保护装置通过狭窄部位并在狭窄远端展开，然后行保护性颈动脉支架成形术，观察围手术期缺血性脑卒中的发生情况，并观察保护装置滤网内捕获的斑块组织碎片。结果26例患者行远端滤网保护下的颈动脉支架成形术均获成功，回收的保护装置中有14个（54％）发现滤网中有斑块碎片组织和血栓颗粒，无死亡及急性栓塞事件发生，但有3例患者在手术后1～6d经磁共振检查发现了新的无症状性脑梗死病灶，26例患者在出院后临床随访期内未发生严重脑缺血事件。结论颈动脉支架成形术是重度症状性颈动脉狭窄的微创治疗方法，术中常规使用远端保护装置可提高颈动脉支架成形术的安全性和有效性。     

MoMa脑保护装置在颈动脉狭窄支架置人术中的作用

目的 探讨颈动脉狭窄支架置人术中使用MoMa脑保护装置的作用.方法 回顾性分析2008年12月-2010年5月,对6例颈内动脉重度狭窄的患者行颈动脉支架置人术并使用MoMa脑保护装置的临床资料.结果 ①6例患者的临床症状均获得改善,NIHSS评分较术前提高1-2分.②保护装置的滤网中均可见捕获的小斑块,无一例患者发生栓子脱落事件,颈内动脉重度狭窄均得到改善（残余狭窄率均〈30%）.③术后3d及3个月复查头部MRI,均未发现新发的缺血病灶.有1例在使用Moma脑保护装置过程中,血液从颈外动脉逆流而加用远端脑保护装置;1例术后出现急性冠状动脉综合征,经积极治疗后好转.6例患者术后3个月复查颈部血管彩超均未发现再狭窄.结论 对颈动脉重度狭窄的患者行支架置人术时,使用MoMa脑保护装置是相对安全、有效的,但尚需大样本病例的进一步研究.     

老年颈动脉支架成形术的随访分析

目的了解老年颈动脉狭窄病人经皮颈动脉成形术及支架植入术(carotidarterystenting,CAS)的有效性及安全性。方法行CAS,颅外段颈动脉狭窄老年患者39例:男28例,女11例;年龄55～81(64±10)岁。随访1年。术前及术后1年行颈动脉超声心动图检查。结果手术成功率为100%,发生微小脑梗死1例;高灌注综合征1例。围手术期及随访中未见死亡及卒中的事件发生,超声检查示狭窄程度明显改善(P<0.001),仅见50%的支架内再狭窄2例(4.9%)。结论老年颅外段颈动脉狭窄的病人CAS是一种简单、安全、可行的手术方式。     

经右侧桡动脉或肱动脉对牛型主动脉弓的左侧颈动脉狭窄患者行颈动脉支架置入术:60例患者的单中心研究

<正>有研究者为了评估经右侧桡动脉或肱动脉入路,对合并牛型主动脉弓的左侧颈动脉狭窄患者行颈动脉支架置入术(CAS)的安全性和有效性,回顾性分析了2007年6月—2012年12月的505例CAS患者,其中60例患者[占11.9%,其中44例为男性,平均年龄(73±9)岁]符合上述条件,其中32例经右侧桡动脉,28例经肱动脉入路。CAS术中的脑保护装置(远端过滤伞或近端MO.MA保护系统)和支架类型     

不符合NASCET纳入标准的高危有症状颈动脉狭窄患者的颈动脉成形支架置入术治疗

目的 探讨支架置入术治疗不符合NASCET纳入标准的高危有症状颈动脉狭窄患者的有效性和安全性.方法 对20例不符合NASCET纳入标准的高危有症状颈动脉狭窄患者进行颈动脉支架置入术治疗,其中男性12例,女性8例,年龄62～76岁(平均69岁),短暂性脑缺血发作11例,脑梗死9例.所有患者数字减影血管造影显示颈动脉狭窄程度＞70%(NA-SCET标准),其中-侧颈动脉重度狭窄9例(2例为内膜切除术后再狭窄),双侧颈动脉重度狭窄6例,一侧颈动脉闭塞伴对侧重度狭窄5例(1例为鼻咽癌放疗术后).所有患者均使用栓子保护装置,均采用预扩张和自膨式支架.结果 手术成功率100%,残余狭窄率均＜30%.所有患者术中均出现不同程度的一过性心率和血压下降,1例患者并发微栓子栓塞.其余患者围手术期内无缺血性卒中发作.术后复查颈动脉超声见狭窄显著改善.术后1个月和3个月随访均未发现同侧缺血性卒中和冠状动脉缺血事件.结论 颈动脉支架置入术创伤小、围手术期并发症少,治疗外科手术高危的有症状颈动脉狭窄是安全和有效的.     

Carotid artery stenting with filter protection

BACKGROUND: Neurologic events associated with distal embolization of debris during percutaneous carotid artery stenting complicate the procedure. Filter devices for cerebral protection potentially reduce the risk of embolization and other neurologic events. We studied the feasibility, safety, and efficacy of carotid artery stenting with a filter device. METHODS AND RESULTS: Between January 2002 and January 2003, a total of 22 consecutive patients (30 lesions) who had >70% diameter stenosis of the internal carotid artery underwent carotid artery stenting with filter protection at our institute. The mean age of the patients was 64+/-9 years; 14 were men and 8 women, and 15 had neurologic symptoms. A stent was successfully implanted in 29 lesions. It was possible to position a filter device in all the 29 lesions. Neurologic complications during the procedure, in the hospital, and at 30-day clinical follow-up occurred in 2 patients. One patient suffered a minor stroke that resolved within 24 hours. None of the patients had a major embolic stroke. There was one death from intracerebral hemorrhage related to hyperperfusion and the use of a glycoprotein IIb/IIIa inhibitor. CONCLUSIONS: Filter protection during carotid artery stenting seems technically feasible, safe, and effective. In the present study, the incidence of embolic neurologic events was low.     

Carotid artery stenting with distal filter protection: single-center experience in high-surgical-risk patients

Carotid artery stenting (CAS) is an efficient alternative procedure for the treatment of high-surgical-risk patients with symptomatic and asymptomatic carotid stenosis. The use of cerebral protection systems might decrease procedural risk of stroke and death. We report our initial experience with protected carotid stenting in high-risk patients with severe carotid artery disease. From January 2006 until July 2008 we routinely performed CAS using a distal filter protection device in 65 consecutive high-surgical-risk patients with 72 high-grade carotid stenoses. Technical success rate was 97.2%. Neurologic periprocedural complications included two transient ischemic attacks and one major stroke. Three filter-related complications were managed without negative results to the patients. The overall in-hospital and 30-days MACE rate was 1.5%, 3.6% in symptomatic patients and 0% in asymptomatic patients. In our series of high-risk patients, CAS with the use of a distal filter protection system was safe and effective with a low incidence of periprocedural complications.     

单中心颈动脉狭窄患者支架植入术的远期疗效

目的 探讨颈动脉狭窄患者行支架植入术的安全性及近、远期疗效.方法 回顾性分析2005年1月至2010年12月在沈阳军区总医院住院的48例颈动脉狭窄患者资料,在远端脑保护装置下植入颈动脉支架,观察其围术期并发症及临床疗效.结果 48例颈动脉狭窄患者,男41例（85.4％）,年龄（66±6.8）岁,靶病变1处/例,病变长度（22.5±10.3）mm,狭窄程度88.5％±9.9％.手术成功率100％,植入颈动脉自膨式支架1枚/例,使用远端滤网保护装置1个/例,支架直径（7.3±2.4）mm,长度（36.0±5.5） mm.术后即刻残余狭窄程度5.6％±4.5％.术中11例（22.9％）出现心率减慢,于术中给予1 mg阿托品静脉注射,心率恢复至正常范围.2例（4.2％）出现一侧肢体活动障碍,经治疗24 h内好转,术后无严重并发症发生.随访（36.2±15.5）个月,随访率93.8％（45/48）,2例（4.4％）患者死亡,其中1例死于肺癌,1例死于缺血性脑卒中,4例（8.9％）患者仍有头晕发作,3例（6.7％）偶有肢体麻木,无严重脑缺血发作,无脑梗死、脑出血发生.术后6～12个月复查增强计算机断层扫描成像示无颈动脉、椎动脉及肾动脉支架内再狭窄.结论 在远端脑保护装置下行颈动脉支架植入术,是治疗颈动脉狭窄安全、有效的手段,手术成功率高,长期临床随访患者仍能从中获益.     

Carotid artery stenting in surgical high-risk patients.

Recent studies have shown that carotid artery angioplasty and stenting may offer a viable alternative for symptomatic and asymptomatic patients with carotid artery stenosis, especially in high-risk patients. We report the results of a prospective single-center registry designed to evaluate the feasibility and safety of carotid artery angioplasty and stenting with and without distal protection devices in high-risk patients. A total of 116 consecutive patients underwent 126 procedures and 127 stents were deployed successfully in 130 lesions. The majority of patients (63%) had restenosis after a prior carotid endarterectomy; 31% were considered to be ineligible for carotid endarterectomy by both the vascular surgeons and the interventional cardiologist and 9% were considered ineligible for surgery due to hostile neck anatomy. Periprocedural and follow-up evaluation included a thorough independent clinical and neurological assessment. Distal embolic protection devices were used in 44% of all cases. Procedural success was achieved in 122 procedures (97%). The overall rate of in-hospital major adverse cerebrovascular events (death, stroke, and myocardial infarction) was 2.6%. Event rates in patients with prior carotid endarterectomy were comparable to patients with de novo lesions with 5.2% vs. 2.4% death/stroke at 30 days and 8.3% and 6.6% stroke/death rates at 1 year, respectively. When distal protection devices were used, death/stroke rates were 0% as compared to 4.5% when distal protection was not used (P = NS). However, minor embolic phenomena were observed in both primary and secondary lesions independent of the use of distal protection. These results support the use of carotid artery angioplasty and stenting in high-risk patients with significant primary or secondary carotid artery stenosis. In both types of lesions, acceptable results justify its use as a valid revascularization method. While clinical embolic events occur in a minority of patients in both lesion types, they are not entirely prevented by distal protection.     

高危症状性颈动脉狭窄支架成形术的疗效分析

目的分析颈动脉支架成形术治疗高危症状性颈动脉狭窄的有效性和安全性。方法对20例高危症状性颈动脉狭窄患者进行颈动脉支架成形术治疗,其中男12例,女8例;年龄为62～76岁,平均69岁。其中短暂性脑缺血发作11例,脑梗死9例。对所有患者均行全脑血管造影,显示颈动脉狭窄率均〉70％,其中一侧颈动脉重度狭窄9例（2例为颈动脉剥脱术后再狭窄）;双侧颈动脉重度狭窄6例;一侧颈动脉闭塞,另--N重度狭窄5例（1例为鼻咽癌放疗术后）。对所有患者使用脑保护装置,并均采用预扩张,预扩张后均使用自膨式支架。结果技术成功率为100％,残余狭窄率均〈30％。所有患者术中均出现不同程度的短暂性心率、血压下降,1例患者出现了微栓子栓塞,无其他严重并发症;其余患者围手术期内无缺血性卒中发作。术后复查颈动脉超声见,显示狭窄明显改善。结论颈动脉支架治疗高危症状性颈动脉狭窄创伤小,围手术期并发症少,是安全、有效的。     

Interventional Management of Asymptomatic Extracranial Carotid Stenosis

Carotid artery stenosis is a major risk factor for stroke and transient ischemic attack. Although carotid endarterectomy is the established gold standard for carotid revascularization, carotid artery angioplasty and stenting (CAS)—proven by large randomized clinical trials and rigorous registries and supported by improving stent designs, embolic protection, and increasing neurointerventionalist experience—is developing into a safer and more efficacious method of stroke prevention. Today, protected CAS is approved for symptomatic and asymptomatic patients with severe carotid stenosis with high surgical risk. We reviewed recently published data regarding new developments in the use of protected CAS, particularly in patients with carotid stenosis who are either asymptomatic or at low surgical risk.     

单中心颈动脉狭窄患者支架植入术的远期疗效

目的探讨颈动脉狭窄患者行支架植入术的安全性及近、远期疗效。方法回顾性分析2005年1月至2010年12月在沈阳军区总医院住院的48例颈动脉狭窄患者,在远端脑保护装置下植入颈动脉支架,观察其围术期并发症及临床疗效。结果48例颈动脉狭窄患者,年龄（66±6.8）岁,男41例（85.4%,41/48）,靶病变1处/例,病变长度（22.5±10.3）mm,狭窄程度88.5%±9.9%。手术成功率100%,植入颈动脉自膨式支架1枚/例,使用远端滤网保护装置1个/例,支架直径（7.3±2.4）mm,长度（36.0±5.5）mm,术后即刻残余狭窄程度5.6%±4.5%。术中11例（22.9%,11/48）出现心率减慢,于术中给予1 mg阿托品静脉注射,心率恢复至正常范围。2例（4.2%,2/48）出现一侧肢体活动障碍,经治疗24 h后好转,术后无严重并发症发生。随访（36.2±15.5）个月,随访率93.8%（45/48）,2例（4.4%,2/48）患者死亡,其中1例死于肺癌,1例死于缺血性脑卒中,4例（8.9%,4/48）患者仍有头晕发作,3例（6.7%,3/48）偶有肢体麻木,无严重脑缺血发作,无脑梗死、脑出血发生。术后6～12个月复查增强计算机断层扫描：无颈动脉、椎动脉及肾动脉支架内再狭窄。结论在远端脑保护装置下行颈动脉支架植入术是治疗颈动脉狭窄安全有效的手段,手术成功率高,长期临床随访患者仍能从中获益。