介入支架植入术治疗单侧颈内动脉狭窄的临床探讨

目的：探讨在远端脑保护装置下，结合围术期处理对介入支架治疗单侧颈内动脉狭窄疗效的影响。方法选择2012年6月至2014年1月该院收治的23例单侧颈内动脉狭窄患者，均行数字减影血管造影（DSA）证实单侧狭窄率大于或等于75％，其中C1段狭窄15例，C2段狭窄8例，在远端脑保护伞保护下，行介入支架植入术治疗。术后给予相应药物治疗及预防并发症。结果23例单侧颈内动脉狭窄患者，经DSA证实，术后狭窄率均低于30％，手术成功率100％，其中1例患者术中球囊扩张时出现血管痉挛（4．3％），2例患者出现穿刺点皮肤及鼻黏膜出血，3例患者出现了不同程度的头痛、恶心、呕吐等症状，对症处理后症状均消失，术后6个月随访，均无栓塞及其他并发症发生。术后随访6个月，患者收缩压和舒张压明显下降（P＜0．05）。介入前后，在年龄（以60岁为界）、性别（女／男）、高血压、陈旧性脑梗死、糖尿病、血脂异常、吸烟（3年以上）等临床病理特征中，差异均无统计学意义（P＞0．05）。结论介入支架植入术能够有效治疗单侧颈内动脉段狭窄，通过术中应用保护伞并在围术期加强观察及对症治疗能够有效地减少和控制手术并发症，改善手术预后。

Interventional stent implantation for treating unilateral internal carotid artery stenosis in 23 cases

Objective To explore the impact of the distal cerebral protection devices combined with the periop‐eration management on interventional stent implantation in the treatment of unilateral internal carotid artery stenosis . Methods 23 patients with unilateral internal carotid artery stenosis more than or equal to 75% confirmed by the dig‐ital subtraction angiography（DSA） ,including 15 cases of C1 segment stenosis and 8 cases of C2 segment stenosis . Under the protection of the distal cerebral protection umbrella ,the interventional stent implantation was performed . After operation the corresponding medication was given for preventing complications .Results In 23 cases of unilat‐eral internal carotid artery stenosis ,the postoperative stenosis was confirmed by DSA and the postoperative stenosis rate was lower than 30% ,the success rate of operation was 100% ,in which 1 case of vascular spasm occurred during intraoperative balloon expansion（4 .3% ） ,2 cases had the skin and nasal bleeding at the puncture point and 3 cases ap‐peared different degrees of headache ,nausea ,vomiting and other symptoms ,the symptoms disappeared after symp‐tomatic treatment .Postoperative follow‐up lasted for 6 months ,no embolism and other complications occurred .Before and after intervention and during 6‐month follow up ,the systolic blood pressure and diastolic blood pressure were significant‐ly decreased（P〈0 .05） .The clinicopathologic characteristics of age（60 years as boundary） ,sex ,old cerebral infarction ,diabe‐tes ,dyslipidemia ,smoking（over three years） ,etc .had no statistically signification differences（P〉0 .05） .Conclusion Inter‐ventional stent implantation is effective in the treatment of unilateral internal carotid artery stenosis ,intraoperatively applying the protective umbrella and strengthening the observation during perioperative period and symptomatic treatment can effec‐tively reduce and control the operation complications ,and improve the operative prognosis .