颅外段颈动脉狭窄自膨式支架成形术临床效果及安全性探讨

目的探讨颈动脉颅外段狭窄应用自膨式支架成形术的手术方法、临床效果及安全性。方法对症状性颈内动脉狭窄〉50％，无症状性狭窄〉75％的颅外段颈动脉狭窄患者，根据血管狭窄情况，选择合适球囊预扩后满意后，将自膨式支架送至预想的位置释放，覆盖狭窄部位。结果78例患者共治疗80支血管，置入81枚支架，配合使用56枚保护伞，支架置入技术成功率为100％。狭窄程度均明显改善，狭窄程度由原来的（87±10）％下降至（13±6）％，狭窄血管最大血流速度从（190±14）cm／s下降至（84±6）cm／s。21例发生短暂性血压及心率下降，29例发生持续性低血压及心率下降，1例（未使用保护伞）术中出现同侧大脑中动脉急性闭塞事件，紧急溶栓、碎栓后血管开通，其余77例术中无中风并发症。13例围术期出现过度灌注表现，无脑出血等严重并发症。术后患者症状均明显改善，随访6～32个月，颈动脉超声检查77例支架内无再狭窄，1例出现再狭窄（〈50％），但患者无症状，继续随访观察。结论应用自膨式支架成形术治疗颈动脉颅外段狭窄临床效果好，只要正确选择适应证，围术期处理得当，并发症少，安全性高。

Clinical effect and safety of endovascular stenting in treatment of extracranial carotid artery ste- nosis with serf-expanding stent

Objective To investigate the clinical effect, safety, technique and potential compli- cations of endovascular stenting in treatment of extracranial carotid artery stenosis with self-expanding stent. Methods Seventy-eight patients, symptomatic carotid artery stenosis 〉 50%, or no symptomatic stenosis 〉75% with extracranial carotid artery stenosis were treated by angioplasty and self-expanding stent placement. Results All 78 patients were treated successfully and 81 stents were implanted in instant angiograph, with 56 pieces of umbrella. The degree of stenosis were significantly improved, the degree of stenosis from （87 ± 10） % to （ 13 ± 6） %, the maximum velocity of stenosis from （ 190 ± 14） cm/s de-creased to （84 ±6）cm/s, 21 cases of transient decline in blood pressure and heart rate, 29 cases with per-sistent hypotension and a decrease in heart rate, 1 case （no using of protective umbrella） had emergency thrombolysis in ipsilateral middle cerebral artery, those 77 patients had no stroke, 13 cases had the per-fusion characteristics, no serious complication such as cerebral hemorrhage. Postoperative symptoms were improved significantly, followed up for 6 - 32 months, 1 case occurred restenosis （ 〈 50% ）, without symptom, continue to follow-up observation. Conclusions The clinical effect of self-expanding stent an-gioplasty on extraeranial carotid artery stenosis is good, if only the correct choice of indications, properly perioperative treatment, less complication, the security is hight.