经皮血管内支架成形术治疗高龄颈动脉狭窄患者的临床研究

目的　对平均80岁以上的高龄颈动脉狭窄患者进行经皮血管内支架成形术治疗的可行性,安全性和效果进行探讨。方法　对18例(年龄76～92岁)单侧颈动脉狭窄和其中1例合并椎动脉狭窄患者经磁共振和数字减影血管造影(DSA)确诊,后行经皮颈动脉支架和椎动脉支架血管内成形手术。结果　19例次支架置放均获成功。DSA显示狭窄段的颈动脉直径明显扩大,同侧颅内脑血管循环时间和染色趋于正常。仅1例出现部分运动性失语。随访3～18个月,无1例再发生脑缺血事件;B超复查未见明显支架内再狭窄。结论　对高龄颈动脉狭窄行经皮血管内成形治疗的安全性高,效果可靠。但需重视预防和及时处理围手术期出现的并发症。

Percutaneous transluminal angioplasty and stenting for elderly cases with stenosis of carotid artery

Objective To evaluate the safety, feasibility and effect of percutaneous transluminal angioplasty and stenting in elderly cases aged 81.5 years in average with stenosis of carotid artery.Methods The procedure of percutaneous transluminal angioplasty and stenting of carotid and vertebral arteries were performed after the diagnosis of single carotid artery stenosis in 18 cases (aged from 76～92 in average) and one of them with vertebral artery stenosis was confirmed by the MR and DSA. Results The placement of all 19 stents was successful. DSA showed that the diameter of stenosed segment of carotid artery was markedly enlarged and circulation time and staining of ipsilateral intracranial cerebral vessels tended to be normal. Only one case suffered from a partial motor aphasia. Following up for 3～18 months, no ischemia attack occurred in all cases by clinical observation and no restenosis was found in stenting angioplasty segment of carotid artery by ultrasonic examination. Conclusion Therapy of carotid stenosis with percutaneous transluminal angioplasty and stenting was satisfactory and safe in elderly cases.But attention should be paid to the prevention and management of the complication during the procedure of treatment.