血管内治疗症状性椎基底动脉颅内段狭窄及闭塞的疗效观察
发布时间：2018-01-24 11:10
本文关键词： 症状性椎基底动脉颅内狭窄 并发症 颅内动脉支架 闭塞再通 出处：《吉林大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的:探讨症状性椎基底动脉颅内段狭窄及闭塞性病变行血管内治疗可行性、安全性、有效性,分析血管内治疗后围手术期主要并发症、支架内再狭窄等出现原因。材料及方法:研究纳入2014年1月至2016年11月在吉林大学第一医院神经内科住院的68名后循环缺血患者,入院后行经DSA检查发现椎基底动脉系统颅内段存在责任血管≥70%狭窄或闭塞性病变,行血管内治疗者为研究对象。采集患者入院时基本资料及高危因素等信息。术前给予至少3-5d的双重抗血小板聚集治疗(阿司匹林100 mg/d+氯吡格雷75 mg/d),术前给予尼莫地平持续静脉泵入预防血管痉挛。根据患者靶病变处血管情况选用支架或球囊扩张治疗,术后低分子肝素40 mg/bid,3d;双重抗血小板聚集治疗(阿司匹林100mg/d+氯吡格雷75 mg/d)6个月,继之长期单一抗血小板聚集治疗。并对患者进行电话或超声检查随访。结果:症状性椎基底动脉颅内段狭窄行支架治疗58例,男性50例,女性8例。年龄59.14±9.15岁。入组患者卒中及预后影响因素。其中合并糖尿病23例,术前仅8例(34.8%)糖化血红蛋白7.0%。症状表现为头晕者44例(75.9%),其中仅出现头晕22例(37.9%)。出现肢体瘫痪17例(29.3%),感觉异常6例(10.3%),言语障碍10例(17.2%),视觉障碍9例(15.5%)。围手术期主要并发症7例(12.8%),靶血管处急性血栓形成4例,蛛网膜下腔出血1例,穿支动脉病变2例。支架再狭窄8例(13.8%),其中出现卒中再发3例,其中1例为合并前循环严重狭窄者供血区卒中。症状性椎基底动脉颅内段闭塞性病变10例,男性8例,女性2例;年龄60.7±6.57岁;3例既往卒中病史,7例高血压病病史,3例糖尿病病史,6例吸烟史,7例术前LDL-C≥1.8mmol/L;6例术前同型半胱氨酸≥15umol/L。症状表现为头晕9例(90.0%)、肢体瘫痪5例(50.0%)、言语障碍(20.0%)2例、感觉异常2例(20%)、视物不清2例(20%)。7例成功开通,3例未成功开通,其中1例应用Apollo支架植入,6例患者应用单纯球囊扩张治疗,围手术期主要并发症出现1例(14.29%)急性血栓形成并行动脉溶栓治疗。术后残余狭窄≤30%3例,残余30%-50%3例,残余70%狭窄1例。平均随访10.3个月(3-19个月),其中4例患者出现支架内再狭窄,2例患者出现卒中再发,其中1例患者出现闭锁综合征后死亡。结论:1.症状性椎基底动脉颅内段狭窄支架治疗技术上具有可行性,具有较高安全性,尚需随机对照双盲研究证据支持。2.椎基底动脉闭塞性病变血管内再通治疗可能改善患者临床预后,技术上具有可行性,但对于再通治疗安全性及有效性尚需大样本的临床研究证据支持。
[Abstract]:Objective: To investigate the symptomatic vertebral basilar artery stenosis and occlusion of intracranial lesions underwent endovascular treatment of feasibility, safety, effectiveness, the main treatment of perioperative complications after endovascular stent restenosis, and other reasons. Materials and methods: the study included in the January 2014 to November 2016 in the hospital neurology department of No.1 Hospital of Jilin University after 68 circulation ischemia patients, patients underwent DSA examination found intracranial vertebrobasilar system has the responsibility of more than 70% vascular stenosis or occlusion underwent endovascular treatment as the research object. Collect patient admission data and risk factors and other information. Preoperative administration of dual antiplatelet aggregation therapy (aspirin at least 3-5d 100 mg/d+ clopidogrel 75 mg/d), preoperative administration of continuous intravenous infusion of nimodipine prevent vasospasm. According to the target lesion vessels of the selection of support or Balloon dilatation therapy, postoperative low molecular weight heparin 40 mg/bid, 3D; dual antiplatelet therapy (aspirin 100mg/d+ and clopidogrel 75 mg/d) 6 months after long-term single antiplatelet therapy. And telephone or ultrasound. Results: the follow-up of patients with symptomatic vertebrobasilar artery stenosis of intracranial stent for the treatment of 58 cases, 50 males, 8 females. Age 59.14 + 9.15 years. Factors into the group of patients with stroke and prognosis. Including 23 cases of diabetes before surgery, only 8 cases (34.8%) of glycosylated hemoglobin 7.0%. symptoms of 44 cases of dizziness (75.9%), of which only 22 cases of dizziness (37.9%) paralysis 17. (29.3% cases), 6 cases of paresthesia (10.3%), 10 cases (17.2%), speech disorder in 9 cases of visual impairment (15.5%). Around the major complication of surgery 7 cases (12.8%), the target blood vessel of acute thrombosis in 4 cases, 1 cases of subarachnoid hemorrhage, 2 cases of perforating artery stent lesions. 鐙獎8渚，
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