颈动脉支架成形术致症状性脑梗死的病因分析

发布时间：2018-06-02 07:00

本文选题：颈动脉支架成形术 + 症状性脑梗死　；参考：《广西医科大学》2017年硕士论文

【摘要】：【目的】总结和分析颈动脉支架成形术引起的症状性脑梗死的病因。【方法】回顾性分析2005年1月至2016年1月期间在广西医科大学第一附属医院神经内科行颈动脉支架成形术并出现症状性脑梗死(Symptomatic cerebral infarction,SCI)的病人。通过术后复查的脑血管造影及头颅影响学检查评估新发的脑梗死病灶及相关的责任血管,回顾颈动脉支架置入手术的术前准备、手术操作过程,分析症状性脑梗死的产生原因。【结果】2005年1月至2016年1月期间共有931例病人行颈动脉支架成形术,其中术后发生症状性脑梗死共23例,约占全部颈动脉支架成形术病人的2.47%。根据发生梗死的责任血管,分为:(1)大脑中动脉供血区相关性脑梗死:20例;(2)大脑前动脉供血区相关性脑梗死:2例;(3)基底动脉供血区相关性脑梗死:1例。分析23例症状性脑梗死发生的病因:(1)血管内不稳定斑块脱落、破溃9例;(2)术中操作不当8例(3)抗血小板药物不足或抗血小板药物抵抗3例;(4)手术过程中长时间血管痉挛2例;(5)不明原因1例。【结论】症状性脑梗死是CAS的并发症之一,CAS术中SCI发生的最常见原因是血管内不稳定斑块脱落、破溃,其次依次为术中操作不当、抗血小板药物不足或抗血小板药物抵抗、术中长时间脑血管痉挛。还有部分为不明原因型。对CAS病人,积极进行术前评估,术中谨慎操作,术后规范用药,减少SCI的发生率。
[Abstract]:[objective] to summarize and analyze the etiology of symptomatic cerebral infarction caused by carotid stenting. [methods] the cervical movement was performed in the Department of Neurology, the first affiliated Hospital of Guangxi Medical University from January 2005 to January 2016. Vein stent angioplasty with symptomatic cerebral infarction (SCI). To evaluate the new cerebral infarction focus and related responsible blood vessels by cerebrovascular angiography and cranial influence examination, and to review the preoperative preparation and operation process of carotid stent implantation. [results] from January 2005 to January 2016, 931 patients underwent carotid stenting, of which 23 had symptomatic cerebral infarction, accounting for 2.47% of the total carotid stenting. According to the responsible vessels of infarction, they were divided into 1: 1) middle cerebral artery supply area associated cerebral infarction (20 cases) cerebral infarction associated with anterior cerebral artery supply area (20 cases) anterior cerebral artery supply area associated cerebral infarction (2 cases) basilar artery supply area associated cerebral infarction (1 case). The etiology of 23 cases of symptomatic cerebral infarction was analyzed. 9 cases with ulceration were improperly operated in 8 cases (3 cases) lack of antiplatelet drugs or 3 cases with anti-platelet drug resistance (3 cases), 2 cases with long term vasospasm during operation, 1 case with unknown cause. [conclusion] symptomatic cerebral infarction is associated with CAS. One of the most common causes of SCI during CAS is the removal of unstable plaque in the blood vessel. Breakdown followed by improper operation, insufficient antiplatelet drugs or anti-platelet drug resistance, and long time cerebral vasospasm during operation. Some of them are of unknown origin. In order to reduce the incidence of SCI, CAS patients should be evaluated before operation, carefully operated during operation and standardized after operation.
【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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