老年颅外段颈动脉狭窄患者的血管内介入治疗及相关问题的探讨

目的　探讨老年 (≥ 70岁 )颅外段颈动脉狭窄患者经皮血管内支架成形术 (PTAS)的适应证、手术方法及围手术期处理等相关问题。方法　本组收集 16例老年颅外段颈动脉狭窄患者经全脑数字减影血管造影 (DSA)检查诊断后 ,均采用经股动脉入路应用自膨式支架行PTAS治疗。结果　 16例颅外段颈动脉狭窄患者术后狭窄段的直径较术前扩大 ,12例达到正常管径的 6 0 %以上 ,4例达到 4 0 % ,有症状的 14例术后临床脑缺血症状和体征明显改善。全部患者无并发症发生。随访 2～ 2 4个月 ,全部患者均未再发生脑缺血 ,其中 2例行DSA复查、6例行多普勒超声复查 ,均无再狭窄发生。结论　PTAS是治疗老年颅外段颈动脉狭窄的简便安全有效方法之一。

The discussion about endovascular interventional treatment for extracranial carotid stenosis and related questions in aged patients

Objective To discuss the questions about indication, operation method and the management during operation of percutaneous transluminal angioplasty and stenting (PTAS) in the aged(≥70 years old) with extracranial carotid stenosis.Method Sixteen cases were diagnosed by digital subtract angiography (DSA) and received PTAS with self-expand stent by the approach of femoral artery.Results The postoperative caliber of the stenotic segment was larger than the preoperative caliber, and increased by over 60% of the normal caliber in 12 cases and over 40% in 4 cases. The clinical symptoms and signs of ischemia were improved obviously after PTAS in 14 cases with ischemia. No complication occurred in the group. During the follow-up for 2～24 months no cerebral ischemic attack occurred in all the cases and no restenosis was found in follow-up examination by DSA in 2 cases and by Doppler in 6 cases.Conclusion PTAS is an easy and safe therapy for aged patients with extracranial carotid stenosis.