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目的探讨应用血管成形支架置入术治疗症状性颅外脑血管狭窄的技术可行性、安全性及治疗效果。方法对经DSA全脑血管造影检查示颅外脑动脉狭窄的10例患者(共13处狭窄血管)行血管成形支架置入术,观察其技术成功率、临床效果及并发症发生情况。结果 (1)支架置入情况:共置入支架13枚,均一次性完成支架放置,技术成功率100%,即刻造影显示残余狭窄率<20%者12处、25%～30%者1处,颅内血管造影显示脑实质血流灌注明显改善。(2)临床效果:术后随访20天至18个月,5例脑梗死患者NIHSS评分由术前的平均2.2分降至术后的平均0.8分,临床症状明显改善;3例TIA患者中的2例随访期未再次发作,另1例术后5个月出现非支架侧血管卒中;1例锁骨下动脉盗血患者未再出现盗血现象,1例后循环缺血患者临床症状明显缓解。(3)并发症发生情况:出现近期症状性并发症2例,系术中出现、术后持续的颈动脉窦反射导致的心率下降,均为一过性,最长持续时间<48h;未发现远期支架相关并发症。结论经皮穿刺血管成形支架置入术治疗颅外脑血管狭窄手术成功率高、安全、临床效果好,适合在有条件的医院开展。
Objective To investigate the technical feasibility, safety and therapeutic effect of angioplasty stenting for the treatment of symptomatic extracranial cerebrovascular stenosis. Methods Ten patients with extracranial cerebral artery stenosis (13 stenosis vessels) underwent DSA angiography were treated with angioplasty stenting. The technical success rate, clinical effect and complication were observed. Results (1) Stent placement: A total of 13 stents were placed, and the stents were placed in a single operation. The technical success rate was 100%. Immediate contrast angiography showed that the residual stenosis rate was less than 20%, and 12 at 25% to 30% , Intracranial angiography showed significant improvement of cerebral parenchymal perfusion. (2) Clinical effect: After 20 days to 18 months of follow-up, the NIHSS score of 5 cerebral infarction patients decreased from an average of 2.2 before surgery to 0.8 after surgery, and the clinical symptoms improved significantly. Among 3 TIA patients Two patients had no recurrent seizures during the follow-up period, and the other one had non-stent-side vascular stroke at 5 months after surgery. One case of steal of blood in the subclavian artery showed no more steal, and one case of post-ischemic ischemia relieved the clinical symptoms. (3) complications occurred: the recent occurrence of symptomatic complications in 2 cases, the Department of surgery, postoperative continuous carotid sinus reflex heart rate decreased, were transient, the longest duration of <48h; not found Long-term stent-related complications. Conclusion The percutaneous transluminal angioplasty stenting has a high success rate in the treatment of extracranial cerebrovascular stenosis, which is safe and has good clinical effect. It is suitable for hospitalization in qualified hospitals.