【摘要】 目的:通过探讨缺血性脑血管病病人接受颅内血管支架成形术和颅外血管支架成形术技术操作的难易度,结合围手术期的治疗观察,进行风险与收益的评估。方法:将我院神经内科2004年8月～2007年5月间,接受经皮腔内支架成形术的51例病人分成颅内段、颅外段两组,颅内血管22例,颅外29例。支架置入点均为引起缺血事件的"责任"血管,颅内血管狭窄率均在50%以上,颅外血管狭窄率60%以上。其中急性血管闭塞应用微导管接触溶栓+微导丝机械疏通+支架成形术治疗8例(颈内动脉开口2例,颈内动脉C6段1例,大脑中动脉5例)。对两组病人技术操作、术后并发症、短期随访(平均21±10.3个月)分别进行统计学处理。结果:颅外29例技术操作全部成功,术中并发症2例,均为颈内动脉开口支架成形术后出现的短暂心率、血压下降。颅内22例技术操作21例成功,术后脑出血3例(其中1例死亡),栓子脱落远端梗塞1例,血管痉挛2例。短期随访中,行颅内支架病人3个月后再狭窄1例。8例急性脑血管闭塞应用微导管接触溶栓+微导丝机械疏通+支架成形术全部获得成功。随访6个月,ESS评分95分以上。结论:颅内血管支架成形术技术操作难度大,而且存在一定的风险性,实施时应慎重;颅外血管支架置入成形术可操作性相对较大,成功率较高,风险相对较小,收益较大;急性脑血管闭塞应用微导管接触溶栓+微导丝机械疏通+支架成形术治疗效果好,患者受益最大。更多还原

【Abstract】 Objective:Achieve the risk and benefits assessment further by investigating the difficulty degree of the technical operation to intracranial vascular stent and extracranial vascular stent placement with observing the surgical treatment.Methods:Total 51 patients with percutaneous transluminal stent therapy in Neurology of our hospital during August 2004 to May 2007 suffered from ischemia incident.The stenting point are all at the "responsible vascular" caused of ischemia incident.The intracranial vascular stenosis rate is more than 50% and the extracranial vascular stenosis rate is more than 60%.These 51 patients were devided into two group-,intracranial(22 patients)and extracranial(29 patiens).There were 8 patients suffered from acute cerebral vascular occlusion(2 cases of internal carotid artery openings,1 case of internal carotid artery C6 paragraph and 5 cases of middle cerebral artery)were treated with micro-contact catheter thrombolysis,micro-guide wire mechanism dredge and stent placement.At last,there was a statistics report on technical operations,postoperative complications and short-term follow-up(average of 21±10.3 months)for two group respectively.Fllow-up of the 6 months,ESS scales were more than 95.Results:29 cases of extracranial technical operations are all successful.Two cases of postoperative complications arises short-term heart rate and blood pressure drop after a internal carotid artery openings stent placement.Among 22 cases of intracranial technical operations,21 cases are successful,3 cases of postoperative cerebral hemorrhage(1 case of dead),one case of distal embolization caused by Embolic exfoliated,2 cases of vsospasm,and one case of restenosis three months later,8 cases of acute cerebral vascular occlusion are all successful.Conclusion:For intracranial vascular stent placement,there is a certain degree of difficulty on technical operations and a certain risks,so the implementation of intracranial vascular stent placement should be cautious.For extracranial vascular stent placement,the operatability is relatively larger,the success rate is higher,the risk is less and the benefits is relatively bigger.For acute cerebral vascular occlusion,the therapeutic effect is good with the application of micro-contact catheter thrombolysis,micro-guide wire mechanism dredge and stent placement,and the patients have greatest benefits.更多还原