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目的观察经皮腔内支架成形术(percutaneous transluminal angioplasty and stenting,PTAS)治疗动脉狭窄性缺血性脑血管病的围手术期并发症及预后,探讨其疗效及安全性。方法对111例接受PTAS治疗的动脉狭窄性缺血性脑血管病患者的临床资料进行回顾性分析。111例患者共放置支架132枚。评估患者围手术期的病死率及神经系统或非神经系统并发症发生率;预后主要评估患者术后1周、6个月及1年的NIHSS评分,以及术后1、12个月内脑血管事件[包括短暂性脑缺血发作(TIA)、脑卒中、血管原因死亡]。结果手术技术成功率100%,经过治疗的患者血管狭窄程度均明显改善;围手术期总体临床并发症发生率为15.3%,其中神经系统并发症为3.6%,病死率为0.9%。67例患者进行了随访,3例(4.5%)患者在1个月内发生脑血管事件:TIA 1例,同侧轻度卒中和对侧轻度卒中各1例,无严重卒中及死亡发生。随访12个月内共发生脑血管事件7例(10.4%):同侧TIA 2例(3.0%),同侧轻度卒中和非同侧轻度卒中各2例(3.0%),严重卒中1例(1.5%),术后1年复查数字减影脑血管造影13例,出现支架内再狭窄2例(15.4%)。随访中患者NIHSS评分较术前明显降低(P<0.05)。结论 PTAS围手术期并发症发生率低,可以明显改善动脉狭窄性缺血性脑血管病患者的神经功能缺损程度和1年的预后,是一种比较安全、有效的治疗方法,但远期疗效有待进一步观察。
Objective To observe the perioperative complications and prognosis of arterial stenosis ischemic cerebrovascular disease by percutaneous transluminal angioplasty and stenting (PTAS), and to evaluate its efficacy and safety. Methods The clinical data of 111 patients with arterial stenosis ischemic cerebrovascular disease receiving PTAS were analyzed retrospectively. 111 patients were placed in a total of 132 stent. Perioperative mortality and the incidence of neurological or non-neurological complications were assessed. The prognosis was evaluated primarily by the NIHSS scores at 1 week, 6 months and 1 year after surgery, and cerebrovascular within 1 and 12 months after surgery Incidents [including transient ischemic attack (TIA), stroke, death from vascular causes]. Results The success rate of surgical technique was 100%. The degree of vascular stenosis in the treated group was significantly improved. The overall clinical complication rate in perioperative period was 15.3%. The incidence of neurological complications was 3.6% and the case fatality rate was 0.9%. Sixty-seven patients were followed up. Three patients (4.5%) developed cerebrovascular events within one month: one case of TIA, one case of mild to moderate stroke and one case of contralateral mild stroke without severe stroke and death. Seven patients (10.4%) had cerebrovascular events within 12 months of follow-up: 2 cases (3.0%) of ipsilateral TIA, 2 cases (3.0%) of ipsilateral mild stroke and non-ipsilateral mild stroke, Cases (1.5%), one year after the review of digital subtraction angiography in 13 cases, two cases of in-stent restenosis (15.4%). The NIHSS score in follow-up was significantly lower than that before operation (P <0.05). Conclusions The low incidence of perioperative complications of PTAS can significantly improve the degree of neurological deficits and 1-year prognosis in patients with arterial stenosis ischemic cerebrovascular disease. It is a safe and effective treatment, but the long-term efficacy Pending further observation.