颈动脉支架内再狭窄（附4例）分析

发布时间：2018-09-11 14:49

【摘要】：目的:通过对4例颈动脉支架内再狭窄(ISR)的病例报道,回顾相关文献资料,探讨该并发症的主要发生机制、危险因素、早期检查方式及预防,从而降低该病发生的几率。方法:回顾我院诊治的4例颈动脉支架内再狭窄病例,分析其临床资料及特点,结合相关文献,进行临床总结。结果:4例患者均存在高血压病史,3例入院后生化检查示胆固醇及甘油三酯不同程度升高,颈内动脉初次狭窄程度均80%,所植入的支架类型均为Wallstent,且4例病变斑块表面均不光滑,无溃疡;1例患者行PCI(冠脉经皮支架置入)治疗,且前循环系统存在颈总动脉及颈内动脉串联狭窄,脑血管重度动脉硬化,术后发生再狭窄时间短;术后残余狭窄率1例为30%,1例为20%,1例5%,1例完全贴壁为0%;术后再狭窄率2例80%,1例70%,1例50%;术后均规律服用抗血小板聚集药物。2例ISR发生时间均为9~12月之间,1例发生时间为术后2月,1例发生于术后6月,属于亚急性期ISR,3例再狭窄发生时出现明显的临床表现;4例患者经再次球囊扩张后随访半年,无缺血症状发作及再狭窄。结论:支架内再狭窄是颈内动脉支架植入术(CAS)后较常见的一种并发症,其发生与支架类型、病变特点及患者本身因素均相关,颈部血管超声为早期诊断再狭窄提供了参考依据,球囊扩张术治疗颈动脉支架内再狭窄是一种安全有效的方式。
[Abstract]:Objective: to study the main mechanism, risk factors, early examination and prevention of restenosis in carotid stents (ISR) in 4 cases, and to reduce the incidence of the disease. Methods: the clinical data and characteristics of 4 cases of carotid stent restenosis in our hospital were reviewed. Results all of the 4 patients had a history of hypertension. Biochemical examination of 3 cases showed that cholesterol and triglyceride increased in varying degrees, and the degree of primary stenosis of the internal carotid artery was 80%. The stents implanted were all Wallstent, and the plaque surface of 4 cases were not smooth. One patient without ulcers was treated with PCI (percutaneous coronary stent implantation), and the common carotid artery and internal carotid artery stenosis were found in the anterior circulatory system, and the severe arteriosclerosis of cerebral vessels was observed. The duration of restenosis was short after operation. The residual stenosis rate was 30% in 1 case, 20 cases in 1 case, and 20 cases in 1 case. The total adherent rate of 1 case was 0. The restenosis rate was 80% in 2 cases, 701 case in 70 cases, and 50 cases in 1 case. The time of occurrence of ISR was 9 ~ 12 months in 2 cases and 50 cases in 1 case. 2 months after operation, 1 case occurred 6 months after operation. There were obvious clinical manifestations of restenosis in subacute ISR,3. 4 patients were followed up for half a year after re-balloon dilatation without ischemic attack and restenosis. Conclusion: Intra-stent restenosis is a common complication after internal carotid artery stent implantation (CAS), and its occurrence is related to the type of stent, pathological characteristics and the factors of patients themselves. Cervical vascular ultrasound provides a reference for early diagnosis of restenosis. Balloon dilatation is a safe and effective method for carotid stent restenosis.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R651.12

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