血管内支架置入术治疗颈内动脉狭窄疗效分析

目的 探讨颈动脉支架置入术（carotid artery stenting，CAS）治疗颈内动脉狭窄疗效及具体应用血管内治疗时的注意事项。方法 共收集70例颈内动脉狭窄程度均大于70%的患者，均有不同程度短暂性脑缺血发作（TIA）及脑梗死病史。32例符合介入手术适应证的患者接受了自膨式支架置入手术，介入手术组均采用脑保护装置。另38例未做手术的患者服用小剂量阿司匹林及波立维等药物干预。所有病例均随访1年，统计病例的转归情况，评估介入手术组的再狭窄情况。结果 介入手术组支架置入成功率为100%，术后残余狭窄<50%。1年内随访，介入手术组：6例仍有TIA发作，2例新发脑梗死（为中灶梗死，且均有支架内再狭窄），年卒中发生率为6.25%；单纯药物干预组：38例患者中4例有新发脑梗死（2例中灶，2例大灶），18例依然有TIA发作，年卒中发生率为10.5%。两组病例1年内TIA及脑梗死卒中事件的比较有统计学意义（P <0.05）。结论 应用脑保护装置行血管内支架置入术是治疗颈动脉狭窄预防卒中较为有效、安全的方法，但远期效果尚有争议。

The curative effect Analysis of Endovascular Stenting for Stenosis of Internal Carotid artery

Objective To investigate the curative effect of endovascular stenting for stenosis of internal carotid artery（ICA） and announcements in specific application. Methods 70 patients of ICA stenosis greater than 70% had different degree history of transient ischemic attack（TIA） and cerebral infarction. The 32 cases who were in line with indication of interventional operation were underwent self-expandable stents under brain protectors, others taken only small dose Asp and Plavix every day. All patients were followed-up for one year to evaluate turnover information and restenosis. Results The successful ratio of imbedding stents was 100%. Postoperativeiy residual stenoses were less than 50%, in one year followed-up, in group of endovascular stenting, 6 patients still had TIA, 2 patients taken placed latest cerebral infarctions（middle size infarctions owing to inside stents restenosis）, incidence rate of year stroke was 6.25%; corresponding, in group of taking medicine, 4 patients taken placed latest cerebral infarctions（2 middle and 2 big size infarctions）, 18 patients still had TIA. incidence rate of year stroke was 10.5%. There was statistical significance by comparing the one year stroke events of two groups（P〈0.05）. Conclusion Endovascular stent angioplasty under brain protectors is a safe and effective means for treating internal carotid stenosis and preventing stroke,but application of advance angioplasty is still to be discussed.