滤器保护下血管内支架成形术治疗颈动脉狭窄的临床研究

目的 探讨滤器保护下血管内支架植入术治疗颈动脉狭窄的安全性与可行性.方法 回顾性分析35例颈动脉狭窄病人的临床资料,均在路图指引下,于狭窄远端植入保护滤器,再沿同轴导丝植入扩张球囊及自膨式支架.其中行单纯支架植入术5例,余均行球囊扩张加支架植入术.结果 所有病人均成功地植入支架,约62.9％的滤器内发现斑块.术中发生急性脑栓塞2例,其中治愈1例,死亡 1例；术后1d发生脑梗死1例,经溶栓治疗后偏瘫症状好转.所有病人随访3～22个月,平均15个月;随访期间无短暂性脑缺血发作、脑梗死.DSA或颈动脉超声复查均未发现颈动脉狭窄.结论 滤器保护下血管内支架植入术是治疗颈动脉狭窄的有效方法,值得临床进一步推广.

Clinical study of endovascular stent implantation for carotid artery stenosis under protection of filter system

Objective To evaluate the feasibility and safety of endovascular stent implantation under protection of filter system for carotid artery stenosis.Methods Clinical data of 35 patients with carotid artery stenosis were analyzed retrospectively.The protection filter was placed in the distal stenosis under the guidance of a road map,and then a balloon and self expansion stent were implanted in the stenosis along a coaxial guide wire.Stenting alone was performed in 5 cases,and stenting in combination with balloon expansion in the others.Results The stents were implanted successfully in all the patients,and the plaque was found in 62.9% of the protection filters.The acute cerebral embolism occurred in 2 patients during the operation,one of which was cured and the other died.The cerebral infarction occurred in 1 case one day after operation,and improved after thrombolytic therapy.All the patients were followed up for mean period of 15 months,ranged from 3 to 22 months.No transient ischemic attack and cerebral infarction occurred,and no restenosis was detected by DSA or ultrasound during the follow-up period.Conclusions Stenting with protection of filter is an effective method for the treatment of carotid artery stenosis,and it is worth to be further popularized.