脑分水岭梗死脑血管介入诊断与治疗的临床研究

目的进一步研究支架辅助血管成形术治疗脑血管狭窄。方法对23例头颅MR I或CT检查表现为脑分水岭梗死患者的临床表现、全脑数字减影血管造影(DSA)及支架辅助血管成形术的相关问题及其疗效进行研究。结果脑分水岭梗死涉及责任病变血管在颈总动脉的3例、颈动脉窦部(C1段)14例、颈内动脉C2段2例、颈内动脉(C5、C6)段4例;左侧病变8例、右侧病变15例。本组23例患者全部接受了支架辅助血管成形术治疗,共涉及责任病变28处,手术成功率为100%。术后6~12个月随访无短暂性脑缺血发作及新发脑梗死。结论动脉粥样硬化脑动脉狭窄所致的脑分水岭梗死在神经影像学(CT或MR I)上有其特殊表现,如果能早期识别诊断,严格地掌握手术适应证,支架辅助血管成形术对治疗脑动脉狭窄所致脑分水岭梗死和预防缺血性脑卒中不失为一种较为安全有效的新方法。

Clinic study of interventional diagnosis and treatment to brain watershed infarction

Objective To treat cerebrovascular stenosis with percutaneous transluminal angioplasty and stenting and analyze the problems of this method and its therapeutic effects.Methods Twenty-three patients with brain watershed infarction proven by CT or MRI because of severe cerebrovascular stenosis were investigated for their clinic features,cerebrovascular digital subtraction angiography(DSA) and neurologic status before operation and after stent placement.Results The offending arteries concerning carotid sinus(C1 segment) in 14 cases,internal carotid artery(C2 segment) in 2 cases,internal carotid artery(C5,6 segment) in 4 cases;The offending arteries involving left artery in 8 cases,right in 15 cases.The percutaneous transluminal angioplasty and stenting for all patients was successful.All patients did not suffer from TIA and stroke in 6-to 12-month follow-up.Conclusion The brain watershed infarction caused by atherosclerotic cerebrovascular stenosis was not an infrequent ischemic cerebrovascular disease.The percutaneous transluminal angioplasty and stenting is an effective treatment for carotid artery or internal carotid artery stenosis.With proper selection of the patients and meticulous technique,percutaneous transluminal angioplasty and stenting should be of safety and efficacy for stroke prevention and treatment.