颈动脉狭窄支架成形术临床效果研究

发布时间：2018-07-05 18:17

本文选题：颈内动脉 + 支架　；参考：《中华脑科疾病与康复杂志(电子版)》2016年01期

【摘要】：目的探讨颈内动脉狭窄支架成形术的适应证、手术方法、临床效果、安全性以及围手术期并发症的防治方法。方法选择2013年1月至2014年6月在我科颈动脉狭窄住院患者,其中20例颈内动脉颅外段狭窄达到支架成形术指征(症状性颈内动脉狭窄50%,无症状性狭窄75%)的患者作为治疗组,给予支架成形术,同时选择20例颈内动脉狭窄虽然到达支架成形术指征,但不愿意接受支架成形术单纯采用保守治疗(控制危险因素+降脂、降压、控制血糖等药物对症治疗)的患者作为对照组。治疗组除给予支架成形术外,同时控制危险因素,降脂、降压、控制血糖药物等对症治疗。手术前后对两组进行颈部血管彩色超声、经颅多普勒超声(TCD)、磁共振血管造影(MRA)、CT灌注(CTP)、数字减影血管造影(DSA)等检查,同时进行美国国立卫生研究院卒中量表(NIHSS)评分和日常生活能力(ADL)评分、6个月内再发卒中的调查等,对有关结果进行统计学分析。结果治疗组支架置入术成功率100%。颈动脉支架成形术后3周测量狭窄程度由原来的(87.65±7.63)%下降至(12.58±4.83)%(P0.01)。5例发生短暂性血压及心率下降,8例发生持续性低血压及心率下降。6例围手术期出现过度灌注表现,无脑出血等严重并发症;治疗组手术前后脑血流量(CBF)、脑血容量(CBV)明显改善(P0.05);治疗组随访6个月,术后无支架内再狭窄;治疗组ADL评分、NIHSS评分均优于对照组(P0.05);治疗组在6个月内无再发卒中,而对照组有4例发生卒中(P0.05),差异有统计学意义(P0.01)。结论颈动脉狭窄支架成形术临床效果好,术后支架内再发狭窄率低,能够明显改善患者生活质量及预防再发卒中,明显优于内科药物保守治疗。
[Abstract]:Objective to investigate the indications, surgical methods, clinical effects, safety and perioperative complications of stent angioplasty for internal carotid artery stenosis. Methods from January 2013 to June 2014, 20 patients with extracranial stenosis of internal carotid artery (50% symptomatic internal carotid artery stenosis, 75% asymptomatic stenosis) were selected as treatment group, and 20 patients with extracranial stenosis of internal carotid artery reached the indication of stent angioplasty (50% of symptomatic internal carotid artery stenosis, 75% of asymptomatic stenosis). Stent angioplasty was given, and 20 cases of internal carotid artery stenosis were selected to reach the indications of stent angioplasty, but they were not willing to be treated with conservative treatment (controlling risk factors, lowering blood pressure, lipid lowering). Control of blood sugar and other drugs for symptomatic treatment) of the patients as a control group. In addition to stenting, the treatment group also controlled risk factors, lipid, blood pressure, blood sugar control drugs and other symptomatic treatment. The two groups were examined by color ultrasound, transcranial Doppler ultrasound (TCD), magnetic resonance angiography (MRA) CT perfusion (CTP) and digital subtraction angiography (DSA) before and after operation. The National Institutes of Health Stroke scale (NIHSS) and activities of Daily living (ADL) were also evaluated. Results the success rate of stent implantation in treatment group was 100%. The degree of stenosis was decreased from (87.65 卤7.63)% to (12.58 卤4.83)% (P0.01) at 3 weeks after carotid stenting. Transient hypotension and heart rate decline occurred in 8 patients with persistent hypotension and decreased heart rate in 6 patients. The cerebral blood flow (CBF) and cerebral blood volume (CBV) were significantly improved before and after operation in the treatment group (P0.05), and the patients in the treatment group were followed up for 6 months without stent restenosis. The ADL score of the treatment group was better than that of the control group (P0.05); the treatment group had no recurrent stroke within 6 months, while the control group had 4 cases of stroke (P0.05), the difference was statistically significant (P0.01). Conclusion Stent angioplasty of carotid artery stenosis has good clinical effect and low rate of recanalization of stent after operation. It can obviously improve the quality of life of patients and prevent recurrent stroke, which is obviously superior to conservative treatment of internal medicine.
【作者单位】：解放军第二六四医院神经外科;
【基金】：2012年山西省科技攻关课题(20120313018-2)
【分类号】：R651.12

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