脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

Why do stroke patients with negative motor evoked potential show poor limb motor function recovery？

Negative motor evoked potentials after cerebral infarction, indicative of poor recovery of limb motor function, tend to be accompanied by changes in fractional anisotropy values and the cerebral pe-duncle area on the affected side, but the characteristics of these changes have not been reported. This study included 57 cases of cerebral infarction whose motor evoked potentials were tested in the 24 hours after the first inspection for diffusion tensor imaging, in which 29 cases were in the negative group and 28 cases in the positive group. Twenty-nine patients with negative motor evoked potentials were divided into two groups according to fractional anisotropy on the affected side of the cerebral peduncle： a fractional anisotropy 〈 0.36 group and a fractional anisotropy 〉 0.36 group. All patients underwent a regular magnetic resonance imaging and a diffusion tensor imaging examina- tion at 1 week, 1, 3, 6 and 12 months after cerebral infarction. The FugI-Meyer scores of their hemiplegic limbs were tested before the magnetic resonance and diffusion tensor imaging exami-nations. In the negative motor evoked potential group, fractional anisotropy in the affected cerebral peduncle declined progressively, which was most obvious in the first 1-3 months after the onset of cerebral infarction. The areas and area asymmetries of the cerebral peduncle on the affected side were significantly decreased at 6 and 12 months after onset. At 12 months after onset, the area asymmetries of the cerebral peduncle on the affected side were lower than the normal lower limit value of 0.83. FugI-Meyer scores in the fractional anisotropy ≥0.36 group were significantly higher than in the fractional anisotropy 〈 0.36 group at 3-12 months after onset. The fractional anisotropy of the cerebral peduncle in the positive motor evoked potential group decreased in the first 1 month after onset, and stayed unchanged from 3-12 months; there was no change in the area of the cerebral peduncle in the first 1-12 months after cerebral infarction. These findings confirmed that if the fractional anisotropy of the cerebral peduncle on the affected side is 〈 0.36 and the area asym-metries 〈 0.83 in patients with negative motor evoked potential after cerebral infarction, then poor hemiplegic limb motor function recovery may occur.     

颈动脉支架置入术后内皮功能的变化及与再狭窄的相关研究

目的 探讨颈动脉支架置入术后假性血友病因子(vWF)、内皮素1(ET-1)的水平变化及与再狭窄的关系.方法 检测67例短暂性脑缺血发作患者行颈动脉支架置人术前,术后1 h、2周、1个月、6个月、1年血浆vWF、ET-1水平.患者术后1年常规进行头颈血管CTA检查,根据结果分为再狭窄组和无狭窄组,并对两组vWF、ET-1水平进行比较.结果 随访中1例死亡,4例失访.14例患者存在不同程度的再狭窄,其中3例再狭窄≥50%.与术前比较,术后1 h、6个月vWF 水平升高,术后1 h、2周、6个月ET-1水平升高,差异均有统计学意义(P<0.05).与无狭窄组比较,再狭窄组术后1 h、2周、6个月vWF水平升高,术后1 h、2周、1个月、6个月ET-1水平升高,差异均有统计学意义(P<0.05).结论 颈动脉支架置入术后短期(2周内)vWF、ET-1水平持续升高,术后6个月再次升高者发生再狭窄的危险性增加,监测vWF、ET-1水平对判断患者的远期预后有一定价值.     

颈动脉支架置入术后内皮功能的变化及与再狭窄的相关研究

目的 探讨颈动脉支架置入术后假性血友病因子(vWF)、内皮素1(ET-1)的水平变化及与再狭窄的关系.方法 检测67例短暂性脑缺血发作患者行颈动脉支架置人术前,术后1 h、2周、1个月、6个月、1年血浆vWF、ET-1水平.患者术后1年常规进行头颈血管CTA检查,根据结果分为再狭窄组和无狭窄组,并对两组vWF、ET-1水平进行比较.结果 随访中1例死亡,4例失访.14例患者存在不同程度的再狭窄,其中3例再狭窄≥50%.与术前比较,术后1 h、6个月vWF 水平升高,术后1 h、2周、6个月ET-1水平升高,差异均有统计学意义(P<0.05).与无狭窄组比较,再狭窄组术后1 h、2周、6个月vWF水平升高,术后1 h、2周、1个月、6个月ET-1水平升高,差异均有统计学意义(P<0.05).结论 颈动脉支架置入术后短期(2周内)vWF、ET-1水平持续升高,术后6个月再次升高者发生再狭窄的危险性增加,监测vWF、ET-1水平对判断患者的远期预后有一定价值.     

短暂性脑缺血发作患者介入治疗术后炎性因子的动态变化及其与再狭窄的关系

目的 探讨短暂性脑缺血发作(TIA)患者行颈动脉支架置入术(CAS)前后白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)的水平变化及其与再狭窄的关系.方法 根据病变情况、手术复杂程度将67例TIA患者分为A组(单支单处病变,置入1个支架,处理1处病变,38例)和B组(单支弥漫性病变或多支多处病变,置入2个支架,处理2处病变,29例),术后1年常规进行头颈血管CTA检查,并根据结果分为再狭窄组(14例)和无狭窄组(48例).检测患者在CAS术前,术后1 h、2周、1个月、6个月、1年血浆IL-6、TNF-α及血清CRP水平,其中CRP检测采用免疫透射比浊法,IL-6、TNF-α检测采用放射免疫测定法.结果随访中1例死亡,4例失访,有14例存在不同程度的狭窄,其中3例再狭窄≥50%.与术前比较,术后1 h、2周、6个月CRP、IL-6水平明显升高,术后1 h、2周、1个月、6个月TNE-α水平明显升高,差异均有统计学意义(P<0.05).与A组比较,B组术后1 h、2周、6个月CRP水平明显升高,术后1 h、2周、1年TNF-α水平明显升高,差异均有统计学意义(P<0.05).与无狭窄组比较,再狭窄组术后1 h、2周、6个月CRP水平明显升高,术后1 h、2周、1个月、6个月IL-6水平明显升高,术后各时间点TNF-α水平明显升高,差异均有统计学意义(P<0.05).结论 IL-6、TNF-α、CRP在CAS后迅速升高,之后逐渐回落,在术后6个月再次出现升高,尤以再狭窄者为著,其可作为预测早期再狭窄的参考指标.     

颅内外动脉狭窄患者血管内支架成形术前后血清超敏C反应蛋白水平的变化

目的 观察颅内外动脉狭窄患者血管内支架成形术前后血清超敏C反应蛋白(hs-CRP)水平的变化.方法 对25例接受血管内支架成形术的颅内外动脉狭窄患者术前、术后3 d及术后6～12个月的血清hs-CRP水平进行检测,并对术后6～12个月血管再狭窄及无再狭窄患者的hs-CRP水平进行比较.结果 25例颅内外动脉狭窄患者血管内支架成形术后3 d及术后6～12个月的血清hs-CRP水平均明显高于术前(均P<0.05) ,术后3 d血清hs-CRP水平与术后6～12个月比较差异无统计学意义(P＞0.05);再狭窄组术后6～12个月时血清hs-CRP水平明显高于无再狭窄组(P<0.05).结论 颅内外动脉狭窄患者血管内支架成形术后血清hs-CRP水平增高,出现术后血管再狭窄的患者升高更显著.     

Time course of prothrombotic and proinflammatory substance release after intracoronary stent implantation

We hypothesized that restenosis after coronary stenting is predicted by elevated levels of markers of thrombus formation and inflammation. Plasma levels of representative markers of inflammation, the thrombin and plasmin activation systems and adhesion molecules were measured in 59 patients with stable angina pectoris before, immediately after and 6 hours (h), 12 h, 24 h, one month and six months after elective stent implantation (radioactive phosphorus-32 stents/RSs/ n = 16, bare-metal stents/BMSs/ n = 43). All patients underwent clinical and angiographic follow-up (FUP) six months after stenting. RSs had significantly higher angiographic severity of restenosis than BMSs (47.1 +/- 20.1% vs. 27.6 +/- 22.0%, p = 0.003). Repeated measures ANOVA revealed significant differences between the BMS and RS groups as regards the increases in plasma levels of vascular cell adhesion molecule-1 (VCAM-1, p = 0.022), plasminogen activator inhibitor-1 (PAI-1, p = 0.047), tissue-type plasminogen activator (tPA, p = 0.047) and CD40 ligand (CD40L, p = 0.038). tPA levels tended to increase immediately after stenting in both groups, whereas the PAI-1 level one month after stenting was elevated significantly only in the RS group. In the RS group, the plasma levels of CD40L were increased at 24 h and six months after stenting, and the VCAM-1 level rose immediately after stenting and remained high during the FUP. Multivariate analysis on pooled laboratory data of both groups revealed elevated levels of VCAM-1 at 12 h and at six months as significant predictors of the severity of stent restenosis. In conclusion, the process of inflammation and thrombosis occurring after coronary interventions seems to be prolonged and enhanced in patients with high-grade restenosis at the follow up.     

术前血清CTRP3,CTRP9水平与缺血性脑卒中患者颈动脉支架成形术后再狭窄的相关性研究

目的 探讨血清补体C1q/肿瘤坏死因子相关蛋白3（Complement-C1q TNF-related protein 3,CTRP3）、补体C1q/肿瘤坏死因子相关蛋白9（Complement-C1q TNF-related protein 9,CTRP9）水平与缺血性脑卒中（Cerebral ischemic stroke,CIS）患者颈动脉支架成形术（Carotid artery stenting,CAS）后支架内再狭窄（In-stent restenosis,ISR）的关系。 方法 选取2018年2月-2021年2月在廊坊市人民医院诊治的234例CIS患者为CIS组,其中CAS后1年内出现ISR的患者作为ISR组（42例）,未出现ISR的患者作为NISR组（192例）;另选择同期体检健康者85例为对照组;检测CIS患者入院后CAS术前、体检健康者体检时血清CTRP3、CTRP9水平;收集CIS患者的临床资料;分析CIS患者血清CTRP3,CTRP9水平与临床指标的相关性、CAS后发生ISR的影响因素,血清CTRP3,CTRP9水平对CIS患者CAS后发生ISR的预测价值。 结果 与对照组比较,CIS组血清CTRP3,CTRP9水平降低（P＜0.05）;与NISR组比较,ISR组血清CTRP3,CTRP9水平降低,术前超敏C反应蛋白（High sensitivity C-reactive protein,hs-CRP）、术前白细胞计数、术前中性粒细胞计数、支架数量、残留狭窄程度比例升高（P＜0.05）;CIS患者血清CTRP3,CTRP9水平与术前hs-CRP水平、术前白细胞计数、术前中性粒细胞计数、支架数量、残留狭窄程度均呈负相关（r<-0.318,P＜0.05）;支架数量多、血清CTRP3低水平、CTRP9低水平为CIS患者CAS后发生ISR的危险因素（P＜0.05）;血清CTRP3,CTRP9、二者联合预测CIS患者CAS后发生ISR的曲线下面积分别为0.811、0.798、0.934,二者联合的预测价值显著高于单一指标（P＜0.05）。 结论 术前血清CTRP3,CTRP9水平异常降低与CIS患者CAS后发生ISR有关,可作为CIS患者CAS后预后评估的生物学指标。     

脑出血患者血小板CD62p、CD42b表达及血浆血栓素B2、6-酮前列腺素-F1a和血管性假血友病因子水平的变化及其意义

目的 研究脑出血患者血小板CD62p、CD42b表达及血浆血栓素B2(TXB2)、6-酮前列腺素-F1a(6-keto-PGF1a)和血管性假血友病因子(vWF)水平的变化及其意义.方法 对46例高血压脑出血患者(脑出血组)发病后＜3 d、1周、2周及20例高血压患者(对照组),用流式细胞仪检测血小板CD62p、CD42b表达,酶联免疫吸附法检测血浆TXB2、6-keto-PGF1a和vWF的水平,并分析脑出血患者血小板CD62p、CD42b表达与血浆vWF水平的相关性.结果 在发病后＜3 d、1周及2周,脑出血组血小板CD62p表达和血浆TXB2、vWF水平及TXB2/6-keto-PGF1a(T/K)比值均明显高于对照组(均P＜0.01).血小板CD42b表达和血浆6-keto-PGF1a水平均明显低于对照组(均P＜0.01).脑出血患者血小板CD62p表达与血浆vWF水平呈正相关(r=0.56,P＜0.01),血小板CD42b表达与血浆vWF水平呈负相关(r=-0.60,P＜0.01).结论 脑出血患者出现血小板CD62p表达和血浆TXB2、vWF水平升高,血小板CD42b表达和血浆6-keto-PGF1a水平降低.提示脑出血后有明显血管内皮功能障碍及血小板活化.     

症状性椎动脉开口处狭窄支架成形术后再狭窄的影响因素分析

目的探讨症状性椎动脉开口处狭窄支架成形术后再狭窄的影响因素。方法收集2010年1月~2015年5月在南京医科大学附属淮安医院住院治疗症状性椎动脉开口处支架成形术的患者的所有临床资料。采用DSA或CTA评估患者术后半年时再狭窄情况,分析再狭窄发生的危险因素。结果 44例资料完整的患者被纳入分析,其中共有11例(25%)患者发生支架术后再狭窄,但发生症状性再狭窄需要再次治疗仅1例。再狭窄组与无再狭窄组性别、年龄、饮酒、高血压、糖尿病、高脂血症、狭窄侧别(左侧、右侧)、术前狭窄率、残余狭窄率和狭窄部位长度、随访时间、支架品牌等比较,差异无统计学意义(均P0.05)。再狭窄组吸烟的比例(54.5%)明显高于无再狭窄组(18.2%)(P=0.045);再狭窄组狭窄处远端正常椎动脉直径[(3.1±0.4)mm]明显小于无再狭窄组[(3.8±0.5)mm](P0.001)。多因素Logistic回归分析显示,吸烟和椎动脉直径是支架成形术后再狭窄的独立影响因素(均P0.05)。结论症状性椎动脉开口处狭窄支架成形术后再狭窄与吸烟和椎动脉直径密切相关。     

颈内动脉狭窄血管内支架置入术对缺血性脑血管病患者血管内皮功能的影响

目的探讨颈内动脉狭窄血管内支架置入术对缺血性脑血管病患者血管内皮功能的影响。方法选取我院2012-05—2014-05收治的86例颈内动脉狭窄缺血性脑血管病患者为研究对象,随机将所有患者分为实验组(43例)和对照组(43例),对照组给予常规西药进行保守治疗,实验组在对照组的基础上实施血管内支架置入术,比较治疗前后2组患者的认知功能变化、血浆中ET-1、vWF、NO水平的变化以及总治愈率。结果治疗前,2组认知功能的各个方面差异均无统计学意义(P0.05),治疗后2组记忆力、回忆能力、语言能力评分差异有统计学意义(P0.05),定向能力、注意力与计算能力评分差异无统计学意义(P0.05),但认知功能总分差异有统计学意义(P0.05);治疗前2组血浆中ET-1、vWF、NO水平差异无统计学意义(P0.05),治疗后2的ET-1、vWF水平均明显升高(P0.05),NO水平明显降低(P0.05),且实验组变化幅度显著高于对照组(P0.05);对照组总治愈率79.07%,实验组为95.35%,实验组显著高于对照组,差异有统计学意义(P0.05)。结论血管内支架置入术对颈内动脉狭窄缺血性脑血管患者的内皮功能有轻微的损伤,但可有效改善患者的认知功能,提高总体疗效。     

High rate of restenosis after carotid artery stenting in patients with high-grade internal carotid artery stenosis

OBJECTIVE: Carotid endarterectomy (CEA) is the gold-standard procedure for the majority of patients with high-grade symptomatic internal carotid artery stenosis and also for specified high-grade asymptomatic stenoses; however, a proportion of patients are treated with carotid endovascular therapy. We aimed to document medium-term clinical and neurosonographical outcome after carotid artery stenting (CAS). METHODS: 53 patients (mean age: 65 +/- 8 years) with high-grade (> or = 70 % by means of duplex sonography) carotid artery stenosis were enrolled into the study. Nineteen patients had asymptomatic, 34 patients had symptomatic stenoses. All patients had a pre-interventional CT, Doppler and duplex sonography, and digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) prior to the procedural DSA. All patients were offered CEA as the gold-standard procedure and as an alternative to CAS. Both clinical and Duplex sonographical follow-up was obtained at day 1 and 7, month 1, month 3, month 6, month 12, and every subsequent 6 months after the procedure. Mean follow-up time was 22 +/- 1.6 months (+/- SEM). RESULTS: 2/53 patients suffered from stroke. A further 2 patients suffered from carotid artery occlusion shortly after CAS. The cumulative rate of restenosis during follow-up was 24.5 % (13/53). Four of these (7.5 %) were of high-grade and led to further interventional or surgical therapy. CONCLUSIONS: A high rate of restenosis was found during follow-up after CAS. Our analysis of non-selected patients emphasizes that CEA remains the gold-standard procedure for the treatment of symptomatic internal carotid artery stenosis. The frequently performed endovascular treatment of carotid stenosis outside the setting of a randomized controlled trial is not supported by our data.