颈动脉粥样硬化性狭窄患者支架置人术围手术期并发症的防治探讨

目的探讨颈动脉支架置入术(CAS)治疗颈动脉粥样硬化性狭窄患者围手术期并发症防治的初步经验。方法回顾性分析413例动脉粥样硬化性颈动脉狭窄患者经全脑血管数字减影血管造影术诊断后,均采用自膨式支架经股动脉入路行CAS治疗,术中及术后严密监控血压、心率、意识等生命体征,并采取综合措施防止并发症的发生。结果 413例患者中,CAS成功412例(99.8%)。CAS前狭窄率70%～95%,CAS后残余狭窄率为0～20%,患者脑缺血症状及体征均有明显改善。脑出血5例,治愈2例,死亡3例;CAS后3 d发生支架内血栓形成1例,经溶栓治疗后血管再通;支架内再狭窄2例,均行二次CAS治疗;消化道出血1例,对症治疗痊愈;股动脉穿刺处假性动脉瘤5例,经超声波引导定点压迫痊愈2例,瘤腔内注射凝血酶治愈3例;临时起搏器电极造成心室壁穿孔引起心包填塞1例,经紧急开胸手术修补治愈;低血压导致心内膜下心肌梗死2例,经适当升压症状缓解。结论 CAS微创安全有效,围手术期应采取综合措施预防CAS后并发症的发生,以确保疗效。

Study of prevention and management of peri-operative complication of CAS for atherosclerotic carotid stenosis

Objective To discuss the preliminary experience of prevention and management of perioperative complications of carotid artery stenting(CAS) for atherosclerotic carotid stenosis.Methods 413 cases who were diagnosed as atherosclerotic carotid stenosis by DSA and received CAS with self-expand stent by femoral artery approach were analyzed retrospectively.The blood pressure, heart rate,consciousness and other vital signs were closely monitored perioperatively and comprehensive measures were taken to prevent complications after CAS.Results The success rate of CAS was 99.8%.The post-operative average rate of stenosis was decreased from 70%- 95% before operation to 0-20%.The clinical symptoms and signs of cerebral ischemia were improved obviously after CAS.Complications:cerebral hemorrhage in five cases,of whom,two were cured and three died;thrombosis in stent in one case 3 days after CAS,which was relieved by thrombolysis;in-stent restenosis in 2 cases who were treated with second CAS;alimentary tract hemorrhage in one case who was cured conservatively;pseudoaneurysm at puncture site in 5 cases, which were cured by precise compression in two and injection of thrombin in three;perforation of ventricular wall caused by temporary pacemaker electrode in one case,which was cured by surgical repair;subendocardial myocardial infarction resulting from post-procedure hypotension in two cases,which was cured by appropriately lifting pressure.Conclusions CAS is a minimally invasive, safe and effective therapy for atherosclerotic carotid stenosis,and comprehensive measures should be taken to prevent the complication after CAS.