脑保护装置下的血管成形和支架置入术治疗颈动脉狭窄

目的探讨颈动脉狭窄患者颈动脉血管成形和支架置入术(CAS)中应用脑保护装置的有效性和安全性。方法颈动脉狭窄患者CAS治疗时,12例应用脑保护装置(滤网型),16例未使用脑保护装置。结果28例颈动脉狭窄患者成功释放31枚自膨式支架。未使用脑保护装置组球囊预扩1次(6·2%),无一例后扩;使用脑保护装置组球囊预扩4次(33·3%),后扩6次(50%)。CAS治疗中,7例(25·0%)患者出现短暂性心率减慢和低血压。回收的脑保护装置中2例(16·7%)肉眼可见组织碎片。使用脑保护装置组在围手术期和随访期无神经并发症;未使用脑保护装置组围手术期发生1例(6·3%)脑梗死,随访期发生1例(6·3%)脑梗死。结论脑保护装置的使用有助于减少颈动脉狭窄患者CAS治疗的神经并发症。

Carotid Angioplasty and Stenting with Cerebral Protection Devices for Carotid Stenosis

Objectives: To explore the safety and efficacy of carotid angioplasty and stenting (CAS) with cerebral protection devices for carotid stenosis. Methods: Twenty-eight patients with carotid stenosis were treated with CAS with (n=12) or without (n=16) cerebral protection devices. Results: Thirty-one self-expandable stents were deployed in 28 patients with carotid stenosis. The lesions in the group without cerebral protection devices were only predilated once (6.2%) with balloon, and none was postdilated. The lesions in the group with cerebral protection devices were predilated 4 times (33.3%) with balloons, and postdilated 6 times (50%) with balloon. Seven patients (25.0%) had transient bradycardia and hypotension during the CAS treatment. Tissue debris could be found in 2 patients (16.7%) with naked eyes in the retrieving cerebral protection devices. No neurological complications were observed in in the group with cerebral protection devices during the perioperative period and follow up. However, one patient in the group without cerebral protection devices had cerebral infarction (6.3%) during the perioperative period, and another had cerebral infarction (6.3%) during the follow up . Conclusions: Cerebral protection devices are helpful to reduce the neurological complications in patients with carotid stenosis during CAS.