经皮颈动脉支架置入术的临床应用及效果Investigation of clinical outcomes of percutaneous carotid artery stenting
罗建方,黄文晖,周颖玲,陈纪言,王硕,王丽娟,詹国华,李光,李瑜辉,谭宁
摘要(Abstract)：
目的评价经皮颈动脉支架置入术对预防缺血性脑卒中的临床效果。方法对30例患者(共32个严重颈动脉狭窄病变)行经皮颈动脉支架置入术,包括男性26例,女性4例,年龄>56岁,其中13例曾患有脑卒中或反复一过性脑缺血;部分患者有高血压、糖尿病及心肌梗死病史。均在术前行颈动脉超声检查及颈动脉及其颅内段血管造影,将支架置入并覆盖颈动脉病变,部分采用远端脑保护装置;在术后均做心脑血管专科及颈动脉超声检查随访。结果选择性颈动脉造影示32个靶病变均有>70%的狭窄,共置入自膨式支架32个,球囊扩张式支架1个,支架置入成功率为97%;使用远端滤网保护装置21例,使用成功率为95%,在回收的滤网中均发现脱落碎片;4例患者在颈动脉支架置入术后顺利完成外科冠状动脉搭桥术;2例患者在术中分别出现靶病变对侧颅内出血和术后急性肺水肿,3d后死亡。在临床随访观察期间,患者均无脑卒中发生,颈动脉超声检查未发现支架置入段再狭窄。结论经皮颈动脉支架置入术是预防缺血性脑卒中的安全有效方法,也是综合治疗缺血性心脑疾病的新方法。远端保护装置的应用是防止术中脑卒中并发症的必要措施。
关键词(KeyWords)： 颈动脉狭窄;支架;脑卒中
基金项目(Foundation):
作者(Author): 罗建方,黄文晖,周颖玲,陈纪言,王硕,王丽娟,詹国华,李光,李瑜辉,谭宁
参考文献(References)：
- 1DiethrichEB,NdiayeM,ReidDB.Stentingincarotidartery:initialexperiencein110patients.JEndovascSurg,1996,3:4244.
- 2武剑,王拥军.颈动脉粥样硬化的评价.国外医学(神经病学神经外科学分册),1997,24:6265.
- 3DavidSai WahHo.Recentadvancesinpercutaneousangioplastyforextracranialcerebrovasculardisease.MedicalProgress,1999,4:912.
- 4HobsonIIRW.Carotidendarterectomy:NASCETandACAStrials.JInternCardiol,1997,10:459462.
- 5MathiasK.Stentplacementinarterioscleroticdiseaseoftheiternalcarotidartery.JInternCardiol,1997,10:469472.
- 6TheronJG,PayelleGG,CoskunO,etal.Carotidarterystenosis:treatmentwithprotectedballoonangioplastyandstentplacement.Radiology,1996,201:627.
- 7OhkiT,VeithFJ.Carotidarterystenting:utilityofcerebralprotectiondevices.JInvasiveCardiol,2001,13:4755.
- 8MehranR,RoubinGS,IyerSS,etal.Neurologiceventsaftercarotidstentingwithdistalprotectionusinganocclusionballoon:finalresultsfromtheCAF啨USATrial.Circulation,2001,104(Suppl):367.
- 9Al MubarakN,RoubinGS,VitekJJ,etal.Effectofthedistal balloonprotectionsystemonmicroembolizationduringcarotidstenting.Circulation,2001,104:19992002.
- 10ParodiJC,LaMuraR,FerreiraM,etal.Initialevaluationofcarotidangioplastyandstentingwiththreedifferentcerebralprotectiondevices.JVascSurg,2000,32:11271136.
- 11ReimerB,CorvajaN,MoshiriS,etal.Cerebralprotectionwithfilterdevicesduringcarotidarterystenting.Circulation,2001,104:1215.
- 12YadavJS,WholeyMH,KuntzRE,etal.Protectedcarotid arterystentingversusendarterectomyinhigh riskpatients.NEnglJMed,2004,351:14931501.
- 13WholeyMH,WholeyM,MathiasK,etal.Globalexperienceincervicalcarotidarterystentplacement.CathetCardiovascInterv,2000,50:160167.