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目的探讨在远端保护装置下行颈动脉支架术对预防缺血性脑卒中的安全性、可行性以及中、远期临床效果。方法对2002—2005年住院的58例颈动脉狭窄超过70%的患者,在置入远端保护伞装置后行颈动脉支架置入术,术后行心脑血管专科及颈动脉超声检查随访。结果 58例患者中57例成功置入远端保护伞装置,远端保护伞装置置人的成功率为98%;59处颈动脉狭窄病变共置入61枚支架,支架置入成功率100%。平均颈动脉狭窄程度由术前的(81.3±19.6)%减少到术后的(6.2±1.3)%。颈动脉狭窄处直径由术前(1.3±0.9)mm 增加到(5.2±1.1)mm;平均住院2.5天;1例患者术中发生小卒中。平均随访时间(14±2)个月,随访期间,2例患者发生无症状性颈动脉狭窄;2例发生心肌梗死;1例发生小卒中;无大卒中及无死亡发生。结论远端保护伞装置置入及在其下进行的经皮颈动脉支架术成功率高、安全性好,能够有效减少近、远期卒中的发生。
Objective To investigate the safety and feasibility of distal carotid artery stenting in the prevention of ischemic stroke and its clinical effect in the long and short term. Methods 58 patients with carotid stenosis of more than 70% who were hospitalized in 2002-2005 were treated with carotid stenting after insertion of distal protective device. Cardiocerebral trauma and carotid ultrasonography were followed up. Results Fifty-seven of 58 patients were successfully placed in the distal protection device. The success rate of distal protection device was 98%. Sixty-nine stent sites were placed in 59 lesions with 100% success rate. The mean carotid artery stenosis decreased from (81.3 ± 19.6)% preoperatively to (6.2 ± 1.3)% postoperatively. The diameter of carotid artery stenosis increased from (1.3 ± 0.9) mm to (5.2 ± 1.1) mm preoperatively, with a mean stay of 2.5 days. One patient developed minor stroke during operation. During the mean follow-up of 14 ± 2 months, 2 patients developed asymptomatic carotid stenosis during follow-up; 2 had a myocardial infarction; 1 had a minor stroke; none had a major stroke and none died. Conclusion The success rate of percutaneous carotid artery stenting with distal umbrella device and its follow-up is high and safe. It can effectively reduce the incidence of proximal and distal stroke.