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目的介绍颅内外动脉狭窄经皮腔内血管支架成形术的基本方法,总结30例治疗经验体会及并发症的发生与防治。方法30例患者38处颅内外动脉狭窄经皮腔内血管支架成形术,共置入支架40个,其中颈内动脉开口18枚,颈内动脉C1段7枚、C3～C5段8枚,锁骨下动脉2枚,椎动脉开口5枚;应用保护伞17例。结果技术成功率100%。21处术后残余狭窄率小于10%,11处为10%～20%,6处为20%～30%。17例脑保护装置均成功释放及回收。7例TIA患者和4例表现有明显头昏的患者症状即刻消失或好转;6例行颈内动脉支架植入术后原来难以控制的高血压病明显降低。1例术后出现持续低血压;2例术中有轻度脑血管痉挛现象;1例入路困难,手术时间明显延长;1例术后出现轻度的高灌注综合征。随访中出现再狭窄1例、术后抑郁症1例。结论颅内外动脉狭窄经皮腔内血管支架成形术是治疗颅内外脑供血动脉狭窄新的有效治疗方法,在严格掌握适应症和有经验的医生操作下治疗是安全的。
Objective To introduce the basic methods of percutaneous transluminal angioplasty in patients with intracranial and extracranial arterial stenosis and to summarize the experiences of 30 cases and the prevention and treatment of complications. Methods Thirty patients with intracranial and extracranial arterial stenosis underwent percutaneous transluminal angioplasty were enrolled. Thirty carotid stents were placed in the 30 patients, including 18 carotid arteries, 7 carotid artery C1, 8 C3 ~ C5, 2 under the artery, 5 vertebral artery openings; application of 17 cases of umbrella. Results of technical success rate of 100%. Residual stenosis rates were less than 10% at 21, 10% -20% at 11 and 20% -30% at 6 locations. 17 cases of brain protection devices were successfully released and recovered. Seven patients with TIA and 4 patients with obvious dizziness disappeared or improved immediately. Six patients with uncontrollable hypertension after carotid artery stenting were significantly reduced. One patient had postoperative persistent hypotension. Two patients had mild cerebral vasospasm. One patient had difficulty in operation and operation time was significantly prolonged. One patient had mild hyperperfusion syndrome after operation. One case of restenosis and one case of postoperative depression were followed up. Conclusion Intracranial and extracranial arterial stenosis percutaneous transluminal angioplasty is a new and effective treatment for intracranial and extracranial cerebral artery stenosis. It is safe to treat with strict indications and experienced doctors.