高危颈动脉狭窄患者的血管腔内治疗

目的探讨高危颈动脉狭窄患者血管腔内治疗的短期疗效和并发症预防。方法对41例高危颈动脉狭窄患者行颈动脉支架植入术,术前狭窄程度为75.0%～98.0%,狭窄长度1.3～3.6 cm,患者均合并一种或多种内科疾病。结果本组均采用脑保护伞及自膨式支架,操作均获得成功,术中颈动脉造影残余狭窄率≤30%。12例患者于术中出现一过性不同程度心率下降,1例患者支架释放后近端出现动脉夹层,1例患者在支架置入后出现失语及右侧肢体偏瘫,无脑出血,经保守治疗14天后症状缓解。随访33例患者,随访时间3～18个月。随访期间,1例死于恶性肿瘤,1例死于心肌梗死,2例出现支架内再狭窄,但无临床症状,其余患者支架无移位,支架内血流通畅,无脑缺血症状。结论对于高危患者,血管腔内治疗近期疗效较好,规范操作可减少并发症的发生。

Endovascular treatment of high risk patients with carotid artery stenosis

Objective To investigate the short termefficacy and the prevention of complications inthe endovascular treatment of high risk patients with carotid artery stenosis.Methods Carotid angioplasty and stenting(CAS) were performed in 41 high risk patients with carotid artery stenosis.All the patients were complicated one or more internal medicine diseases.The extent of stenosis was 75.0 %—98.0 %,and the length of stenosis was 1.3—3.6 cmbefore operation.Results All the patients were treated with the brain protector and the self-expandable stents.The procedures were all technically successful,and the remanent stenosis of carotid artery wereless than or equal to 30 %.In operation,12 patients had transient heart rate decrease,proxi mal common carotid artery occurred dissectionin 1 patient.After operation,1 patient deveoped aphasia and right hemiplegia without cerebral hemorrhage,whose symptoms disappeared after 2 weeks’ conservative treatment.Totally 33 patients were followed upfor 3—18 months.One patient died of malignancy,1 died of myocardial infarction and 2 had stent restenosis but without clinical symptoms.The stents were well-displaced and the blood flows instents were unobstructed,and there was no cerebral ischemia in the remaining patients.Conclusion For high-risk patients,CAS has good short termcurative effect,and standardized operation can reduce the incidence of complications.