血管内支架治疗症状性颈总动脉弓上开口狭窄的临床分析

发布时间：2018-04-14 13:26

本文选题：颈总动脉弓上狭窄 + 球囊扩张式支架　；参考：《广西医科大学》2017年硕士论文

【摘要】：【目的】探讨球囊扩张式支架治疗症状性颈总动脉弓上开口狭窄的有效性及安全性。【方法】对经颅脑CT血管成像(CTA)或脑血管造影术(DSA)证实为椎动脉起始部重度狭窄(70%)的52例症状性颈总动脉弓上开口重度狭窄患者进行血管内支架治疗,男34例,女18例,年龄52岁~79岁,平均(65.39±8.97)岁。术前完善一般常规生化、颅脑CT或MRI、CTA、DSA等检查,并于入院和出院时进行NIHSS评分,血管狭窄程度采用北美症状性颈动脉内膜切除试验(NASCET)测量颈内动脉狭窄的方法进行评价。在局部麻醉下,以改良Seldinger技术穿刺股动脉,置入动脉鞘,沿0.035inch微导丝送入球囊扩张式支架,并观察围手术期并发症。【结果】52例颈总动脉弓上开口狭窄的患者进行了血管内支架置入术,共置入支架51枚,手术成功率为98.08%。远端脑保护装置均未在手术操作过程中使用。围手术期的并发症为5.77%,其中包括术中大脑中动脉水平段栓塞1例,引起大面积的脑梗死;术后高灌注综合征2例;1例手术失败。手术前后NIHSS评分(6.21±2.20,2.25±1.80,P0.05)、狭窄率(87.90%±7.60%,8.40%±2.30%,P0.05),差异有统计学意义。【结论】球囊扩张式支架治疗症状性颈总动脉弓上开口狭窄是一种有效、安全的方法,并发症发生率低和近期效果好。
[Abstract]:[objective] to investigate the efficacy and safety of balloon dilated stents in the treatment of symptomatic stenosis of the superior carotid arch. [methods] Transcraniocerebral CT angiography (CTAA) or cerebrovascular angiography (DSAs) proved to be severe at the beginning of vertebral artery.52 patients with severe stenosis of the superior arch of the common carotid artery were treated with endovascular stenting.There were 34 males and 18 females, aged 52 years or 79 years, with an average age of 65.39 卤8.97 years.Before operation, routine biochemical examination, CT or MRII-CTA DSA were performed, and NIHSS scores were evaluated at admission and discharge. The degree of stenosis was evaluated by the method of North American symptomatic carotid endarterectomy test (NASCET) for the measurement of internal carotid artery stenosis.Under local anesthesia, the femoral artery was punctured with modified Seldinger technique, and the sheath was inserted into the artery sheath, which was fed into the balloon dilated stent along the 0.035inch microlead wire.The complications of perioperative period were observed. [results] Fifty-two patients with stenosis of superior carotid arch were implanted with 51 stents, the success rate was 98.08.The distal cerebral protective devices were not used during the operation.The complications in perioperative period were 5.77%, including 1 case of horizontal embolization of middle cerebral artery, 1 case of massive cerebral infarction, 2 cases of postoperative hyperperfusion syndrome and 1 case of failure of operation.The NIHSS score before and after operation was 6.21 卤2.20 卤2.25 卤1.80 P 0.05, and the stenosis rate was 87.90% 卤7.60% 卤2.30% 卤2.30%. The difference was statistically significant. [conclusion] the balloon dilated stent is an effective and safe method for the treatment of symptomatic stenosis of the superior carotid artery arch, with low complication rate and good short-term effect.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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