血管内支架治疗颈动脉及椎动脉狭窄的20例临床分析

目的探讨血管内支架治疗颈动脉及椎动脉狭窄的安全性及有效性。资料与方法对20例颈、椎动脉狭窄行颈动脉球囊扩张及支架成形术(CAS)治疗的患者作回顾性分析,对临床表现、治疗方法及治疗前后的影像资料改变进行分析。结果 20例患者行CAS治疗,共成功放置支架22枚,11例采用颈动脉保护装置。术前干预血管平均狭窄度(76.2±11.4)%,术后支架膨胀不满意采用球囊后扩者3例。术后造影显示15例残余狭窄度<10%,4例<20%,仅1例<38%,术后平均狭窄度(12.4±8.2)%。治疗前后狭窄度比较有显著统计学意义(P<0.001)。随访平均(12.3±5.6)个月,7例支架术后6个月发现支架有不同程度再狭窄,但再狭窄率均未超过30%,均无神经系统症状。结论血管内支架治疗颈动脉及椎动脉狭窄是安全和有效的,近期随访无严重再狭窄(>50%)及颅内严重并发症发生。     

移植肾动脉狭窄的介入治疗

目的探讨移植肾动脉狭窄(TRAS)的介入治疗方法. 资料与方法采用经皮血管内成形术(PTA)和/或内支架治疗20例TRAS患者,对其技术成功率、再狭窄率以及狭窄类型对介入治疗的影响进行分析. 结果 (1)PTA和内支架治疗TRAS的技术成功率分别为71.4%、100%,再狭窄率分别为20%、22.2%.(2)Ⅰ型、Ⅱ型、Ⅲ型狭窄介入治疗的技术成功率分别为92.9%、85.7%,0,再狭窄率分别为23.1%、16.7%. 结论 (1)Ⅰ型、Ⅱ型狭窄为介入治疗的良好适应证.(2)PTA依然为TRAS的首选方法,内支架为其辅助手段.     

介入治疗移植肾动脉狭窄的疗效观察

目的　评价介入治疗移植肾动脉狭窄 (TRAS)的疗效。资料与方法　 2 0 0 0年 1月～ 2 0 0 2年 11月 ,采用经皮血管内成形术 (PTA)和 /或内支架治疗 2 0例TRAS患者 ,其中PTA治疗 14例次 ,内支架治疗 9例次。对治疗前后的血压、降压药物和血肌酐进行随访。结果　采用PTA治疗者 ,收缩压、舒张压、降压药物和血肌酐由术前的(15 7± 17)mmHg、(97± 7)mmHg、(1.5± 1.0 )种、(5 12± 2 96 ) μmol/L ,术后 1周降为 (137± 11)mmHg(P <0 .0 5 )、(86± 7)mmHg(P <0 .0 1)、(0 .9± 1.0 )种 (P >0 .0 5 )、(2 76± 2 2 6 ) μmol/L(P <0 .0 5 ) ,术后 6个月降为 (12 8±10 )mmHg(P <0 .0 1)、(83± 7)mmHg(P <0 .0 1)、(0 .8± 0 .9)种 (P >0 .0 5 )、(14 5± 5 5 ) μmol/L(P <0 .0 1)。采用内支架治疗者 ,收缩压、舒张压、降压药物和血肌酐由术前的 (15 4± 31)mmHg、(93± 12 )mmHg、(1.6± 1.0 )种、(338±14 2 ) μmol/L ,术后 1周降为 (134± 17)mmHg(P >0 .0 5 )、(82± 7)mmHg(P <0 .0 5 )、(0 .8± 1.0 )种 (P >0 .0 5 )、(197±76 ) μmol/L(P <0 .0 5 ) ,术后 6个月为 (132± 9)mmHg(P >0 .0 5 )、(83± 4 )mmHg(P <0 .0 5 )、(0 .5± 0 .8)种 (P >0 .0 5 )、(2 0 4± 16 9) μmol/L(P <0 .0 5 )。总     

金属支架治疗大气道狭窄

目的　探讨气管支架成形术缓解大气道狭窄的方法、安全性和疗效。资料与方法　气管狭窄患者 32例 ,其中气管切开或插管后局部组织过度增生 7例 ,转移性肿瘤压迫气管 12例 ,多发性软骨炎引起气管塌陷 1例 ,肺癌 12例 ;单纯气管狭窄 2 8例 ,主支气管狭窄 1例 ,气管支气管同时有狭窄者 3例。术前均经CT检查及气管体层片证实气管、支气管狭窄。 13例术前用的卡因喷喉麻醉 ,19例在全身麻醉下置入支架。结果　 32例共放置 37枚气管支架 ,均一次置入成功 ,无操作失败 ,通气全部得到改善 ,手术成功率 10 0 %。 2例气管狭窄经置入支架后复发狭窄再次置入支架。 33枚置于气管 ,4枚置于主支气管。 1例狭窄严重仅容 4F导管通过 ,用球囊导管扩张至 12mm后置入支架 ;其余均直接置入支架。术后通气功能明显改善 ,无需吸氧 ,无明显胸痛、咯血等并发症。 1周后X线复查无支架移位 ,可见支架进一步扩张。 1例甲状腺癌支架置入术后 2周复发呼吸困难 ,CT扫描示支架内有新生物 ,经支架内放射治疗后症状消失。结论　气管内支架成形术方法简单、安全 ,缓解呼吸困难疗效迅速、确实 ,适合良恶性气道狭窄姑息治疗     

Treatment of Benign Tracheal Stenosis Utilizing Self-Expanding Nitinol Stents

We assessed the results of self-expanding metallic stent insertion into benign proximal tracheal stenosis in patients not appropriate or unfit for surgical repair. Proximal benign tracheal stenoses had occurred in 11 patients (7 men, 4 women, mean age 68.8 years) after long-time intubation (n = 6), tracheostomy (n = 4), or chondropathia (n = 1). Fourteen self-expanding nitinol stents were placed in the patients under general anesthesia with endoscopical and fluoroscopical guidance. Stent insertion was successful in all cases and led to immediate relief of the morphological and functional airway obstruction. No immediate complications were noted. During the mean follow-up period of 67.5 weeks we observed one recurrent dyspnea 3 months after implantation and granuloma formation at the stent insertion site in another patient. Both complications were successfully treated with additional stent insertion in one case and laser resection of granulomas in the other. Self-expanding nitinol stents should be considered for the treatment of benign proximal tracheal obstruction in selected patients for whom surgical repair is contraindicated.     

血管内支架成形术治疗症状性颅内动脉狭窄

目的：探讨血管内支架成形术治疗颅内动脉狭窄的可行性及疗效。材料和方法：对27例症状性颅内动脉狭窄行血管内支架成形术,其中颈内动脉颅内段狭窄8例、大脑中动脉狭窄11例、基底动脉狭窄1例和椎动脉颅内段狭窄7处。结果：27例中,支架成形术成功26例(96．3%),狭窄程度从术前76．3±10．1%降至术后8．2±6．9%。其中1例因颈内动脉虹吸段过度迂曲导致支架植入失败,2例术后24h内发生颅内出血,1例术后发生支架内血栓再形成,无手术死亡。22例随访0．5～1a(平均7．5个月),无缺血性脑卒中发生。结论：血管内支架成形术是治疗颅内动脉狭窄的有效方法,具有较高的成功率及一定的安全性,但长期疗效有待于进一步随访。     

Stent Fracture and Reocclusion After Placement of a Single Self-Expanding Stent in the Common Iliac Artery and Endovascular Treatment

We present a case of fracture of a single self-expanding stent placed in the common iliac artery (CIA). An 80-year-old woman underwent placement of a self-expanding stent for CIA occlusion. Stent fracture and reocclusion were detected after 18 months. Successful revascularization was achieved using a stent-in-stent maneuver. The possibility of stent fracture with reocclusion should be considered following treatment with a single self-expanding stent for CIA occlusion.     

可回收覆膜支架治疗难治性食管良性狭窄

目的　评价可回收覆膜支架治疗食管良性狭窄的可行性、安全性及其疗效。方法　食管良性狭窄患者 10例 ,在X线监视下置入国产可回收覆膜支架 10枚 ,其中Z型不锈钢丝支架 2枚、网状镍钛合金支架 8枚。在置入 1～ 16周后用回收钩或胃镜将支架取出。结果　 10枚支架均一次置入成功 ,支架置入后患者吞咽困难症状均有明显改善 ,能进普食 ,并在 1～ 16周后成功取出。支架取出后随访 6个月～ 3年 ,1例于支架取出后 1个月再次出现吞咽不畅 ,经反复食管球囊扩张术后症状改善 ,其余病例均未复发。结论　可回收覆膜支架是治疗食管良性狭窄的安全、简便、有效的方法 ,支架在体内的最佳持续留置时间有待于进一步研究     

颈动脉狭窄在脑保护装置下的支架置入治疗

目的探讨颈动脉狭窄患者支架治疗中的脑保护装置的有效性和安全性及治疗意义。方法对14例颈动脉狭窄患者进行血管内支架治疗。全部应用了脑保护装置(滤网型)。结果14例患者成功地释放了18枚自膨式支架。其中2例发生微栓子脱落轻度卒中,治疗1～3d完全恢复,颈动脉狭窄6例出现短暂性心率减慢和低血压。随访期所有患者均未发生脑梗死。结论在支架治疗中,脑保护装置的应用可减少治疗中的神经并发症,是一种有效和安全的治疗方法。     

Endovascular treatment of extracranial vertebral artery stenosis

Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.     

移植肾动脉狭窄的介入治疗

目的研究移植肾动脉狭窄(TRAS)的临床特点及介入治疗的疗效。方法回顾性分析TRAS患者的临床资料,排除临床资料不完整者,分析总结其临床特点、诊断方法及介入治疗的疗效。结果共搜集病例31例,行介入手术35次。6例行单纯球囊扩张(PTA),24例行支架置入,1例手术失败。术后肾动脉狭窄程度、肾功能及血压明显改善,围手术期未发生严重并发症;平均随访29.6个月,PTA术后2例(33.3%)复发狭窄,行支架置入术无复发;支架术后3例(12.5%)再发狭窄,2例成功行PTA术后无复发。结论肾移植术后密切超声随访有利于早期诊断TRAS,介入治疗TRAS安全、有效且应被视为一线治疗方法。     

粥样硬化性肾动脉狭窄介入治疗的临床疗效分析

目的分析和观察粥样硬化性肾动脉狭窄(ARAS)患者介入治疗术后的临床疗效及影响因素。资料与方法对50例动脉粥样硬化患者65支肾动脉狭窄行经皮腔内肾动脉成形术(PTRA)(包括球囊扩张术和支架置入术),术后1个月、6个月、12个月、24个月随访血压、抗高血压药用药情况、血肌酐及再狭窄情况。结果 50例患者中,术后1、6、12个月全部成功随访,但术后24个月有15例失访。技术成功率为98%,术后1个月、6个月、12个月、24个月血压分别较术前有明显下降(P<0.05),血压控制的临床有效率(治愈+改善)分别为94%、74%、64%和51%,抗高血压药由术前平均3.5种,术后1个月、6个月、12个月平均下降分别为1种、2种、3种,24个月又恢复到3.5种。血清肌酐值与基础值相比无显著差异,术后6个月肾功能改善、稳定及恶化例数分别为12例(24%)、29例(58%)和8例(16%);术后12个月肾功能稳定及恶化例数分别为39例(78%)和11例(22%);术后24个月肾功能稳定及恶化例数分别为26例(74%)和8例(16%)。术后6个月、12个月、24个月支架内再狭窄发生率分别为6.8%、15%、20%。结论 PTR...     

自膨式金属内支架在食管狭窄中的应用

本文报道了１５个带有硅酮内膜的自膨式金属Ｇ一ＲＺ型内支架在食管狭窄中的应用结果。在Ｘ线透视下经口放置，１０例恶性食管狭窄和２例良性狭窄全部成功，未发生技术性并发症或死亡。放置２４～４８ｈ后，吞咽程度由术前平均４．５级降至１．５级，均能进普食或软食；１２例中５例有并发症，其中３例内支架移位，２例食物嵌塞，另有７例轻度胸痛。随访观察１～５个月，１１例仍存活，１例死于心衰，内支架均保持通畅。结果提示，食管自膨式金属内支架放置操作简单、安全，是食管狭窄和食管天气管瘘有效的保守疗法。     

Endovascular Treatment of a Vertebral Artery Pseudoaneurysm in a Drug User

A 26-year-old drug abuser who presented with sepsis was found to have a pseudoaneurysm in the left vertebral artery. This aneurysm was presumed to be post-traumatic, since the patient reported multiple attempts to inject drugs in the left jugular vein 15 days prior to admission. The pseudoaneurysm was treated effectively with stent-graft placement.     

Renal Infarction Caused by Spontaneous Renal Artery Dissection: Treatment with Catheter-Directed Thrombolysis and Stenting

Spontaneous renal artery dissection (SRAD) is rare and presents a diagnostic and therapeutic challenge. We report a case of a 36-year-old man who had an SRAD-complicated renal infarction. The patient experienced severe unilateral flank pain. Enhanced abdominal computed axial tomography scan showed renal infarction, and urinalysis showed no hematuria. Selective renal angiography was essential to evaluate the extent of dissection and suitability for repair. The patient was treated with catheter-directed thrombolysis and frenal artery stenting.     

Vertebral artery ostial stent placement for atherosclerotic stenosis in 72 consecutive patients: clinical outcomes and follow-up results

Introduction  The study’s purpose is to report the technical and clinical outcomes of a patient cohort that underwent vertebral artery ostium stent placement for atherosclerotic stenosis. Methods  We retrospectively analyzed a prospectively collected database of neurointerventional procedures performed at a single center from 1999 to 2005. Outcome measures included recurrent transient neurological deficits (TNDs), stroke, and death. Kaplan–Meier analysis was used to estimate stroke- and/or death-free survival at 12 months. Cox proportional hazard was used to identify risk factors for recurrent vertebrobasilar ischemic events. Results  Seventy-two patients with 77 treated vertebral ostial lesions were included. The 30-day stroke and/or death rate was 5.2% (n = 4), although no event was directly related to the vertebral ostium stent placement. Three procedure-related strokes were secondary to attempted stent placement at other sites (one carotid artery and two basilar arteries), and the one death was secondary to the presenting stroke severity. The mean clinical follow-up time available for 66 patients was 9 months. There were 14 TNDs (21%), two strokes (3%), and two deaths (3%) recorded in the follow-up. Recurrent vertebrobasilar ischemic events occurred in nine patients (seven TNDs and two strokes). No recurrent stroke and/or deaths were related to the treated vertebral ostium. Stroke- and/or death-free survival rate (including periprocedural stroke and/or death) was 89 ± 5% at 12 months. No vascular risk factor was significantly associated with recurrent vertebrobasilar ischemic events. Conclusions  Vertebral artery ostium stent placement can be safely and effectively performed with a low rate of recurrent stroke in the territory of the treated vessel. Patients who also underwent attempted treatment of a tandem intracranial stenosis appeared to be at highest risk for periprocedure stroke.     

症状性椎基底动脉狭窄的内支架成形术

目的　研究内支架成形术治疗症状性椎基底动脉狭窄的效果和安全性。方法　 2 0 0 1年 6月至 2 0 0 2年 4月间 ,16例症状性椎基底动脉狭窄患者接受了成形术。结果　 7例为一侧椎动脉狭窄、对侧椎动脉狭窄或闭塞 ,7例为优势侧椎动脉狭窄或对侧椎动脉仅供血小脑后下动脉区域 ,1例为基底动脉狭窄 (孤立性后组循环 ) ,1例为狭窄的椎动脉直接与小脑后下动脉延续。狭窄段位于椎动脉开口部 10例 ,位于颅内段 6例 ,1例患者为椎动脉近端 2处狭窄。MoriA型病变 12例 ,B型病变 3例 ,C型病变 1例。全组技术成功率 10 0 % ,平均狭窄率从 73.2 % (5 0 %～ 95 % )下降到 5 .1% (0～ 30 % ) ,P <0 .0 1。在围手术期内无严重并发症发生。随访 1～ 12个月 (平均 4 .4个月 ) ,按Malek评分 ,疗效极好 15例 ,疗效较好 1例。结论　对症状性基底动脉狭窄进行内支架成形术是安全和有效的方法 ,但长期疗效需要进一步积累病例和随访研究。     

经皮腔内血管成形和支架植入术治疗椎基底动脉狭窄

目的　探讨经皮腔内血管成形和支架植入术治疗椎基底动脉狭窄的效果和安全性。方法　 2 0 0 3年 4月至 2 0 0 4年 6月间 ,2 8例椎基底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　 2 8例患者 ,18例为优势侧椎动脉狭窄 ,4例为双侧椎动脉狭窄 ,3例为一侧椎动脉狭窄、对侧椎动脉闭塞 ,1例为串联狭窄 ,2例为基底动脉狭窄。狭窄段位于椎动脉开口 7例 ,位于颈部椎动脉 2例 ,位于颅内段 17例。MoriA型病变 2 4例 ,B型病变 3例 ,C型病变 1例。全组技术成功率 10 0 % ,术前2 8例平均狭窄率为 81.3% ,术后残余狭窄率均 <10 % ,(P <0 .0 1)。所有病例在围手术期内均未发生严重并发症。本组随访 17例患者 ,时间为 6个月 ,Malek评分为 1分者 15例 ,2分者 2例。DSA脑血管造影复查 3例均未见支架内再狭窄。结论　经皮腔内血管成形和支架植入术是治疗椎基底动脉供血不足 ,预防椎基底动脉系统卒中的安全、有效方法 ;近期预后良好     

Improvement in Claudication After Angioplasty of Distal Ostial Collateral Stenosis in Patients with Long-Segment Occlusion of the Femoral Artery

Purpose: To evaluate the angiographic and clinical effects of percutaneous transluminal angioplasty (PTA) of distal ostial collateral stenoses in patients with claudication and long-segment occlusion of the superficial femoral artery (SFA). Methods: In ten patients (9 men, 1 woman) with stable intermittent claudication due to chronic long-segment occlusion of the SFA a high-grade stenosis of the distal collateral ostium of the deep femoral artery to the popliteal artery were dilated. PTA was performed using popliteal artery access. Claudication distances on the treadmill and ankle-brachial pressure indices (ABI) at rest were analyzed before, 1 week, and 14 weeks after PTA. Results: Initial technical success was obtained in all patients. There were no significant periprocedural local complications. The initial mean claudication distance on the treadmill increased significantly from 107 ± 65 m to 306 ± 209 m (p < 0.01), the maximal claudication distance from 203 ± 128 m to 392 ± 167 m (p < 0.01). The mean ABI changed slightly but significantly (0.61 ± 0.08 vs. 0.64 ± 0.07; p < 0.05). Early follow-up after 14 weeks revealed no clinical deterioration. Conclusion: This new technique is considered helpful in patients with well-defined claudication and long-segment occlusion of the SFA.     

过滤伞保护下的颈动脉狭窄支架成形术

目的 分析过滤伞保护下颈动脉狭窄支架成形术的安全及有效性。方法 25例症状性颈动脉狭窄支架成形术中采用过滤伞装置，首先将过滤伞通过狭窄部位并释放，然后进行狭窄的血管内支架成形术，观察手术期脑栓塞发生的情况，大体观察回收的过滤伞。结果 25例过滤伞放置及支架成形术均成功实施，回收的过滤伞中15个发现组织碎片，无手术死亡及症状性脑血栓栓塞并发症，临床短期随访无脑缺血事件发生。结论 过滤伞的保护作用能提高颈动脉狭窄支架成形术的安全性。