颈动脉狭窄支架成形术围手术期颅内出血原因及防治

目的 探讨颈动脉狭窄患者行支架成形术围手术期颅内出血的可能原因及预防措施.方法 2003年1月至2009年8月,403 例粥样硬化性颈动脉狭窄患者行支架成形治疗,围手术期5例发生颅内出血,回顾性分析其病例特点及围手术期处理措施,总结发生出血的可能原因及预防措施.结果 5例支架置入术后30 min和5 d发现脑出血各2例,3 d发现脑出血1例.保守治疗1例(出血量约2 ml),行脑室穿刺引流1例,开颅手术清除血肿并去骨瓣减压3例.出血部位均在支架置入侧,其中2例出血位于原脑梗死区域.1例保守治愈;1例行脑室引流治疗因病情加重死亡;3例经开颅手术清除血肿及去骨瓣减压,1 例遗留轻度神经功能缺失,2 例死于多器官功能衰竭.结论 颅内出血是颈动脉支架成形术围手术期最为严重的并发症,应采取综合措施预防其发生.

Cause and treatment for intracranial hemorrhage during the perioperative period of carotid artery stenting

Objectives To discuss the possible cause of intracranial hemorrhage and treatment after carotid artery stenting(CAS)in patients with carotid artery stenosis.Methods From January 2003 to August 2009,403 patients with carotid artery stenosis that were performed CAS,intracranial hemorrhage occurred in 5 cases after the procedure.We analyzed the feature of these cases and perioperative management retrospectively to summarize the possible cause of intracranial hemorrhage and preventive measure.Results Cerebral hemorrhage were found 30 min after CAS in 2 cases.5 days in 2 cases and 3 days in 1 case.One patient was treated conservatively whose hemorrhage was about 2 ml,one was performed draining of ventricle and the other three cases were all performed craniotomy to remove the hematoma and to depress.The position of hemorrhage were all in the side of carotid artery stenosis,and in 2 cases of them the hemorrhage were at the region of previous cerebral infarction.One patient was cured conservatively,the one who was performed draining of ventricle died.Among the other three cases performed craniotomy,one recovered with light neurological deftcit and two died of multiple organ failure.Conclusion Intracranial hemorrhage is the most serions complication of CAS of carotid artery,and general measure should be taken to prevent it from occurring.