颅内外血管狭窄支架治疗的风险评估
发布时间：2019-03-29 15:27
【摘要】：目的:本研究旨在探讨脑血管狭窄在行支架术时,颅内外血管存在风险的差异。通过观察在围手术期以及围手术期后1年内出现与支架相关的不良反应以及并发症情况,为临床上预防和减少手术风险提供有益信息。方法:选取2009~2012年于沧州市中心医院神经内科进行脑血管支架置入治疗的200例颅内外血管狭窄患者为研究对象,分为颈内动脉狭窄组和颈动脉颅内段狭窄组2组,颈内动脉狭窄组100例,颈动脉颅内段狭窄组100例。支架置入点均为引起脑缺血事件的相关血管。对两组患者技术操作、术后并发症、术后1年随访资料分别进行统计学分析处理。结果:1围手术期内,颈内动脉狭窄组100例技术操作全部成功,术中并发症15例,分别为(血压和心率下降)迷走反射导致心率及血压下降、(缺血性卒中)脑梗死、皮下血肿、假(性)层动脉瘤、(一过性脑缺血)短暂性脑缺血发作等;颈动脉颅内段狭窄组100例技术操作中有97例成功,2例死亡,1例支架置入失败后进行经皮血管腔内血管成形术,手术成功率为97%,死亡率为2%,术中并发症17例,分别为缺血性卒中、动脉夹层、血管痉挛、呼吸和心跳骤停等。2颈内动脉狭窄组经支架置入治疗后,其血管狭窄率由治疗前的(75.68±7.32)%减小为(12.45±9.34)%;颈动脉颅内段狭窄组由治疗前的(74.93±11.33)%减小为(26.78±13.44)%,两者与术前比较狭窄程度均得到改善(P0.05)。3颈内动脉狭窄组患者术后1年随访,血管闭塞率为2%(2/100)例,新发脑梗死为3%(3/100),短暂性脑缺血率为14%(14/100),脑出血率为1%(1/100);颈动脉颅内段狭窄组术后1年随访,血管闭塞率为7.14%(7/98),新发脑梗死为18.37%(18/98),短暂性脑缺血率为29.59%(29/98),无脑出血事件发生。颈内动脉组血管闭塞率、新发脑梗死率、短暂性脑缺血率均显著低于颈动脉颅内段狭窄组,差异具有统计学意义(P0.05),而2组的脑出血率差异不显著(P0.05)。4所有入组患者术后1年支架段血管再狭窄率随访结果显示,颈内动脉组轻度狭窄6例、中度狭窄3例、重度狭窄1例,再狭窄发生率为10%(10/100);颈动脉颅内段狭窄组轻度狭窄9例,中度狭窄10例,重度狭窄3例,再狭窄率为22.45%(22/98)。颈动脉颅内段狭窄组与颈内动脉组相比术后1年支架再狭窄率显著增高,差异具有统计学意义(P0.05)。5颅内外血管狭窄危险因素分析显示,患者血清HCY水平与动脉狭窄程度呈正比(P0.01);血清hr-CRP与动脉狭窄程度呈正比(P0.05);血清HDL水平与动脉狭窄程度呈负相关(P0.05);血清LDL水平与动脉狭窄程度呈正比(P0.05)。Logistic回归分析结果表明,糖尿病、高血压是引起颅内外血管狭窄的主要危险因素(P0.05)。结论:颅内血管支架成形术技术操作难度较大,同时也存在较大的风险,手术治疗时应慎重;颅外血管支架置入成形术较颅内置入而言可操作性大,成功率高,风险相对较小。
[Abstract]:Objective: the purpose of this study was to investigate the risk difference of extracranial and extracranial vessels in patients with cerebral vascular stenosis undergoing stenting. By observing the side effects and complications related to stents in perioperative period and one year after perioperative period, we can provide useful information for clinical prevention and reduction of surgical risk. Methods: from 2009 to 2012, 200 patients with extracranial and extracranial vascular stenosis were selected and divided into two groups: internal carotid artery stenosis group and carotid intracranial segment stenosis group, which were treated by stent placement in Cangzhou Central Hospital, Department of Neurology, Cangzhou Central Hospital. Internal carotid artery stenosis group (100 cases) and carotid intracranial segment stenosis group (100 cases). Stent placement points are related to cerebral ischemia events. The technical operation, postoperative complications and 1-year follow-up data of the two groups were analyzed statistically. Results: 1 during perioperative period, all 100 cases of internal carotid artery stenosis were operated successfully, 15 cases of complications were (blood pressure and heart rate decrease) caused by vagus reflex, and cerebral infarction (ischemic stroke) were caused by vagal reflex, respectively, in the group of internal carotid artery stenosis, 100 cases of internal carotid artery stenosis were operated successfully. Subcutaneous hematoma, pseudo-(sexual) layer aneurysm, (transient cerebral ischemia) transient ischemic attack, etc. Among 100 cases of carotid intracranial stenosis, 97 cases were successful and 2 cases died. One case underwent percutaneous transluminal angioplasty after failed stent placement. The success rate and mortality rate were 97%, 2% and 17 cases, respectively. The stenosis rate of internal carotid artery was decreased from (75.68 卤7.32)% to (12.45 卤9.34)% after stenting in the group of internal carotid artery stenosis (ICA), including ischemic stroke, dissection of artery, vasospasm, respiration and cardiac arrest, etc. The rate of stenosis in the group of internal carotid artery stenosis was decreased from (75.68 卤7.32)% to (12.45 卤9.34)%. The stenosis of intracranial segment of carotid artery decreased from (74.93 卤11.33)% before treatment to (26.78 卤13.44)%, and the degree of stenosis was improved (P0.05). 3The patients in internal carotid artery stenosis group were followed up one year after operation, and the rate of stenosis was decreased from (74.93 卤11.33)% before treatment to (26.78 卤13.44)% before treatment. Vascular occlusion rate was 2% (2 / 100), new cerebral infarction was 3% (3 / 100), transient cerebral ischemia was 14% (14 / 100), and cerebral hemorrhage rate was 1% (1 / 100). The occlusion rate was 7.14% (7 / 98), the new cerebral infarction was 18.37% (18 / 98) and the transient cerebral ischemia rate was 29.59% (29 / 98). The occlusion rate, new cerebral infarction rate and transient cerebral ischemia rate in the internal carotid artery group were significantly lower than those in the carotid intracranial segment stenosis group (P0.05). There was no significant difference in the rate of cerebral hemorrhage between the two groups (P0.05). (4) the follow-up results showed that there were 6 mild stenosis, 3 moderate stenosis and 1 severe stenosis in the internal carotid artery group one year after operation. The incidence of restenosis was 10% (10 / 100). In the group of intracranial stenosis of carotid artery, 9 cases were mild stenosis, 10 cases were moderate stenosis and 3 cases were severe stenosis. The restenosis rate was 22.45% (22 / 98). The restenosis rate of stent in carotid intracranial segment stenosis group was significantly higher than that in internal carotid artery group 1 year after operation (P0.05). (5) risk factors analysis of extracranial and extracranial artery stenosis showed that the rate of stent restenosis was significantly higher than that of internal carotid artery group. The level of serum HCY was positively correlated with the degree of arterial stenosis (P0.01). The level of serum hr-CRP was positively correlated with the degree of arterial stenosis (P0.05), and the level of serum HDL was negatively correlated with the degree of arterial stenosis (P0.05). The level of serum LDL was positively correlated with the degree of arterial stenosis (P0.05). Logistic regression analysis showed that diabetes mellitus and hypertension were the main risk factors for extracranial and extracranial vascular stenosis (P0.05). Conclusion: the technique of intracranial angioplasty is difficult and there is also a great risk, so we should be careful in surgical treatment, and the operation of extracranial stent implantation is more maneuverable than that of intracranial stenting, the success rate is high, and the risk is relatively small.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：2449664
[Abstract]:Objective: the purpose of this study was to investigate the risk difference of extracranial and extracranial vessels in patients with cerebral vascular stenosis undergoing stenting. By observing the side effects and complications related to stents in perioperative period and one year after perioperative period, we can provide useful information for clinical prevention and reduction of surgical risk. Methods: from 2009 to 2012, 200 patients with extracranial and extracranial vascular stenosis were selected and divided into two groups: internal carotid artery stenosis group and carotid intracranial segment stenosis group, which were treated by stent placement in Cangzhou Central Hospital, Department of Neurology, Cangzhou Central Hospital. Internal carotid artery stenosis group (100 cases) and carotid intracranial segment stenosis group (100 cases). Stent placement points are related to cerebral ischemia events. The technical operation, postoperative complications and 1-year follow-up data of the two groups were analyzed statistically. Results: 1 during perioperative period, all 100 cases of internal carotid artery stenosis were operated successfully, 15 cases of complications were (blood pressure and heart rate decrease) caused by vagus reflex, and cerebral infarction (ischemic stroke) were caused by vagal reflex, respectively, in the group of internal carotid artery stenosis, 100 cases of internal carotid artery stenosis were operated successfully. Subcutaneous hematoma, pseudo-(sexual) layer aneurysm, (transient cerebral ischemia) transient ischemic attack, etc. Among 100 cases of carotid intracranial stenosis, 97 cases were successful and 2 cases died. One case underwent percutaneous transluminal angioplasty after failed stent placement. The success rate and mortality rate were 97%, 2% and 17 cases, respectively. The stenosis rate of internal carotid artery was decreased from (75.68 卤7.32)% to (12.45 卤9.34)% after stenting in the group of internal carotid artery stenosis (ICA), including ischemic stroke, dissection of artery, vasospasm, respiration and cardiac arrest, etc. The rate of stenosis in the group of internal carotid artery stenosis was decreased from (75.68 卤7.32)% to (12.45 卤9.34)%. The stenosis of intracranial segment of carotid artery decreased from (74.93 卤11.33)% before treatment to (26.78 卤13.44)%, and the degree of stenosis was improved (P0.05). 3The patients in internal carotid artery stenosis group were followed up one year after operation, and the rate of stenosis was decreased from (74.93 卤11.33)% before treatment to (26.78 卤13.44)% before treatment. Vascular occlusion rate was 2% (2 / 100), new cerebral infarction was 3% (3 / 100), transient cerebral ischemia was 14% (14 / 100), and cerebral hemorrhage rate was 1% (1 / 100). The occlusion rate was 7.14% (7 / 98), the new cerebral infarction was 18.37% (18 / 98) and the transient cerebral ischemia rate was 29.59% (29 / 98). The occlusion rate, new cerebral infarction rate and transient cerebral ischemia rate in the internal carotid artery group were significantly lower than those in the carotid intracranial segment stenosis group (P0.05). There was no significant difference in the rate of cerebral hemorrhage between the two groups (P0.05). (4) the follow-up results showed that there were 6 mild stenosis, 3 moderate stenosis and 1 severe stenosis in the internal carotid artery group one year after operation. The incidence of restenosis was 10% (10 / 100). In the group of intracranial stenosis of carotid artery, 9 cases were mild stenosis, 10 cases were moderate stenosis and 3 cases were severe stenosis. The restenosis rate was 22.45% (22 / 98). The restenosis rate of stent in carotid intracranial segment stenosis group was significantly higher than that in internal carotid artery group 1 year after operation (P0.05). (5) risk factors analysis of extracranial and extracranial artery stenosis showed that the rate of stent restenosis was significantly higher than that of internal carotid artery group. The level of serum HCY was positively correlated with the degree of arterial stenosis (P0.01). The level of serum hr-CRP was positively correlated with the degree of arterial stenosis (P0.05), and the level of serum HDL was negatively correlated with the degree of arterial stenosis (P0.05). The level of serum LDL was positively correlated with the degree of arterial stenosis (P0.05). Logistic regression analysis showed that diabetes mellitus and hypertension were the main risk factors for extracranial and extracranial vascular stenosis (P0.05). Conclusion: the technique of intracranial angioplasty is difficult and there is also a great risk, so we should be careful in surgical treatment, and the operation of extracranial stent implantation is more maneuverable than that of intracranial stenting, the success rate is high, and the risk is relatively small.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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