高危短暂性脑缺血发作患者颅内外血管狭窄特点及介入治疗

目的:通过全脑血管造影(DSA)研究高危短暂性脑缺血发作(TIA)患者的颅内外血管狭窄特点及介入治疗的效果.方法:126例住院治疗的TIA患者均常规行头颅CT检查以排除脑出血,经头颈部CTA检查证实存在颅内外血管狭窄行DSA检查,观察患者颅内、颅外血管狭窄的部位、范围、程度及有无溃疡粥样硬化斑块.据ABCD2评分系统进行危险度分级,以评分评估患者神经功能,对于责任血管中度及以上狭窄的高危TIA患者71例行血管内支架成形术.分别于术前、术后3、6、9、12、18、24、32个月对支架治疗患者采用ABCD评分系统进行评估.结果:支架治疗的71例患者术后的神经功能显著优于术前(P＜0.05),另外7例侧支循环丰富患者,随访期内无TIA复发.结论:高危TIA患者颅内外血管狭窄并存多见,狭窄程度更重,累及多支血管,代偿不充分是其发作的主要原因,高危TIA以颅外血管狭窄多见,前循环最好发的部位是颈内动脉,后循环最好发部位是椎动脉,及早行狭窄部位血管内支架成形术是治疗高危TIA发作的有效方法.

The characteristics of Intracranial Vascular Stenosis and Interventional Therapy in Patients with High- risk

Objective:The objective of this thesis is to investigate via Digital Subtraction angiography(DSA) the interventional therapy for Intracranial vascular stenosis caused by High risk Transient Ischemic Attack(TIA).Methods:126 hospitalized TIA patients was excluded the possibility of cerebral hemorrhage by CT inspection.CTA at Head and Neck proved the occurrence of Intracranial vascular stenosis,hence DSA was given.The analysis included the observation of patients’arcus aortae,carotid artery,internal carotid,vertebral artery and base artery.The target is to spot the location,range,degree and occurrence of Ulcer atherosclerotic plaque.The diagnosis was given based on the scoring system of "ABCD2" to evaluate patients’ neural functions.Artery support surgery will be given to those(71 out of 126) in danger of TIA’s threat.Their situation was followed up in the 3 rd,6 th,9 th,12 th,18 th,24 th and 32 th month right after the surgery.Results:The result revealed that artery support surgery recovered their neural function largely(P<0.05).TIA did not recur within the follow-up period on another seven patients whose side limb circulation was in good status.Conclusion:The conclusion of the thesis is that high risk TIA mostly appears together with intracranial vascular stenosis which was more severe and affected more vascular sections.Under compensation is the main cause.High risk TIA is accompanied more often by extra cranial vascular stenosis.Internal carotid artery is the place of possible occurrence in frontal circulation while vertebral artery the place in dorsal circulation.Early stenting angioplasty is the most effective way to avoid the occurrence of TIA.