支架置入术治疗症状性弓上颅外动脉狭窄的疗效及安全性研究

目的：探讨支架置入治疗症状性弓上颅外动脉狭窄(SECAS)的疗效及安全性。方法纳入我院神经内科2011年1月至2014年12月收治的SECAS患者32例，完善相关影像学检查后行支架置入术，观察其技术成功率、围手术期并发症发生率、1年支架再狭窄率、卒中复发率和死亡率。结果颈内动脉起始段狭窄支架置入24例、椎动脉开口狭窄支架置入12例、锁骨下动脉狭窄支架置入2例，其中6例为同期行颈动脉和椎动脉支架置入术，技术成功率为100%；颈动脉支架患者18例发生颈动脉窦反应，5例磁共振弥散成像发现无症状性腔隙性梗死灶，1例出现穿刺部位损伤，1例出现桥脑腔隙性梗死，所有患者未出现永久性神经损害；无动脉夹层、支架内急性血栓形成、脑出血和心肌梗死等并发症。随访1年，1例椎动脉支架狭窄，无临床症状；无卒中复发和死亡患者。结论支架置入术是一种治疗SECAS安全、有效的方法，严格纳入患者和规范操作有利于减少并发症发生。

Clinical efficacy and safety of stenting for symptomatic supra-arch extracranial artery stenosis

Objective To investigate the efficacy and safety of stenting for treating patients with symptomatic-supra-arch extracranial artery stenosis (SECAS). Methods Thirty-two SECAS patients included in our hospital from January 2011 to December 2014 underwent stenting after routine imaging examination. The technical success rate, peri-operative complication rate, stent restenosis rate, stroke recurrence and mortality were investigated. Results There were carotid artery stenting in 24 cases, vertebral artery stenting in 12 cases and subclavian artery stenting in 2 cases, in-cluding 6 cases with both carotid artery and vertebral artery stenting. The technical success rate of was 100%. Carotid sinus reaction occurred in 18 cases in patients with carotid artery stenting. Asymptomatic lacunar infarctions were detected in 5 cases of MR diffusion weighed imaging. Injury at the puncture point occurred in 1 case. Pontine lacunar infarction oc-curred in 1 case. None of the patients had permanent nerve damage. Aortic dissection, acute stent thrombosis, cerebral hem-orrhage and myocardial infarction did not occurred. During the follow-up of 1 year, vertebral artery stent restenosis was found in 1 case without clinical symptoms. None of the patients had recurrence of stroke. Conclusion Stenting is a safe and effective method for patients with SECAS. Strict inclusion criteria and standardized operations will help to reduce the complications of stenting.