摘要
目的 探讨症状性颅内动脉狭窄支架血管内成型术并发症的原因及预防措施。方法对4 8例症状性颅内动脉狭窄患者手术并发症进行分析。 4 8例中择期手术 4 0例 ,均有至少一次发作与血管狭窄有关的神经功能障碍 ,内科治疗效果不明显。 8例患者急性动脉内血栓形成 ,经动脉内溶栓再通后发现重度血管狭窄 ,遂行支架置入术。其中大脑中动脉 17例 ,颈内动脉末段 5例 ,基底动脉 8例 ,椎动脉颅内段 18例。结果 4 8例患者中 4 6例术后即刻血管造影显示狭窄程度 ,从术前平均 83%下降到 5 %左右。 4例出现与手术有关的并发症 ,病变分别位于颈内动脉末端 1例 ,大脑中动脉 1例 ,基底动脉 1例。原因包括微导丝穿破皮质动脉致颅内出血 1例 ;1例在手术过程中血管破裂出血 ,破裂后经开颅夹闭破裂血管 ,术后未遗留明显神经功能障碍 ;1例术后出现与穿支动脉闭塞有关的症状 ,对症治疗后恢复。支架术后 2 4h血栓形成 1例 ,溶栓后再通但症状加重 ,最后死亡。结论经皮支架辅助血管成型术为动脉粥样硬化性颅内动脉狭窄提供了一个新的治疗方法 ,但是有待长期技术探索和评价 ,以提高操作技术减低并发症。
Objective To discuss the safety of intracranial stenting for refractory symptomatic intracranial artery stenosis. Methods Forty-eight patients with symptomatic intracranial artery stenosis were treated by transluminal stent-assistant angioplasty. Of them, 40 cases were selected because they had recurrent TIAs or mild stroke despite of antiplatelet or anticoagulation therapy; 8 cases with high-grade stenosis after acute cerebral artery theromblysis. Lesions involved MCA (17/48); Basilar artery (8/48); intracranial vertebral artery (18/18); and distal ICA (5/18). Results For 46 of 48 cases the flexible coronary stent were successfully deployed. The average stenosis reduced from 83% to 5%, short-term follow-up showed good clinical improvement. Complications include vessel rupture (1 /18); acute thrombosis within stent (1/48); perforation of cortical artery (1/18) and perforate vessel occlusion (1/18). Conclusion Stent-assistant angioplasty are effective for treatment of symptomatic intracranial stenosis, the higher rate of complications may be because of the limited experiences of this technique. it need further practise and long term follow-up study.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2003年第16期1402-1405,共4页
National Medical Journal of China
关键词
颅内动脉狭窄支架
血管内成型术
并发症
原因
预防
Intracranial arterial diseases
Intracranial artery stenosis
Stents
Postoperative complications
Intraoperative complications
