本文關(guān)鍵詞： 癥狀性椎基底動(dòng)脈顱內(nèi)狹窄 并發(fā)癥 顱內(nèi)動(dòng)脈支架 閉塞再通　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討癥狀性椎基底動(dòng)脈顱內(nèi)段狹窄及閉塞性病變行血管內(nèi)治療可行性、安全性、有效性,分析血管內(nèi)治療后圍手術(shù)期主要并發(fā)癥、支架內(nèi)再狹窄等出現(xiàn)原因。材料及方法:研究納入2014年1月至2016年11月在吉林大學(xué)第一醫(yī)院神經(jīng)內(nèi)科住院的68名后循環(huán)缺血患者,入院后行經(jīng)DSA檢查發(fā)現(xiàn)椎基底動(dòng)脈系統(tǒng)顱內(nèi)段存在責(zé)任血管≥70%狹窄或閉塞性病變,行血管內(nèi)治療者為研究對(duì)象。采集患者入院時(shí)基本資料及高危因素等信息。術(shù)前給予至少3-5d的雙重抗血小板聚集治療(阿司匹林100 mg/d+氯吡格雷75 mg/d),術(shù)前給予尼莫地平持續(xù)靜脈泵入預(yù)防血管痙攣。根據(jù)患者靶病變處血管情況選用支架或球囊擴(kuò)張治療,術(shù)后低分子肝素40 mg/bid,3d;雙重抗血小板聚集治療(阿司匹林100mg/d+氯吡格雷75 mg/d)6個(gè)月,繼之長期單一抗血小板聚集治療。并對(duì)患者進(jìn)行電話或超聲檢查隨訪。結(jié)果:癥狀性椎基底動(dòng)脈顱內(nèi)段狹窄行支架治療58例,男性50例,女性8例。年齡59.14±9.15歲。入組患者卒中及預(yù)后影響因素。其中合并糖尿病23例,術(shù)前僅8例(34.8%)糖化血紅蛋白7.0%。癥狀表現(xiàn)為頭暈者44例(75.9%),其中僅出現(xiàn)頭暈22例(37.9%)。出現(xiàn)肢體癱瘓17例(29.3%),感覺異常6例(10.3%),言語障礙10例(17.2%),視覺障礙9例(15.5%)。圍手術(shù)期主要并發(fā)癥7例(12.8%),靶血管處急性血栓形成4例,蛛網(wǎng)膜下腔出血1例,穿支動(dòng)脈病變2例。支架再狹窄8例(13.8%),其中出現(xiàn)卒中再發(fā)3例,其中1例為合并前循環(huán)嚴(yán)重狹窄者供血區(qū)卒中。癥狀性椎基底動(dòng)脈顱內(nèi)段閉塞性病變10例,男性8例,女性2例;年齡60.7±6.57歲;3例既往卒中病史,7例高血壓病病史,3例糖尿病病史,6例吸煙史,7例術(shù)前LDL-C≥1.8mmol/L;6例術(shù)前同型半胱氨酸≥15umol/L。癥狀表現(xiàn)為頭暈9例(90.0%)、肢體癱瘓5例(50.0%)、言語障礙(20.0%)2例、感覺異常2例(20%)、視物不清2例(20%)。7例成功開通,3例未成功開通,其中1例應(yīng)用Apollo支架植入,6例患者應(yīng)用單純球囊擴(kuò)張治療,圍手術(shù)期主要并發(fā)癥出現(xiàn)1例(14.29%)急性血栓形成并行動(dòng)脈溶栓治療。術(shù)后殘余狹窄≤30%3例,殘余30%-50%3例,殘余70%狹窄1例。平均隨訪10.3個(gè)月(3-19個(gè)月),其中4例患者出現(xiàn)支架內(nèi)再狹窄,2例患者出現(xiàn)卒中再發(fā),其中1例患者出現(xiàn)閉鎖綜合征后死亡。結(jié)論:1.癥狀性椎基底動(dòng)脈顱內(nèi)段狹窄支架治療技術(shù)上具有可行性,具有較高安全性,尚需隨機(jī)對(duì)照雙盲研究證據(jù)支持。2.椎基底動(dòng)脈閉塞性病變血管內(nèi)再通治療可能改善患者臨床預(yù)后,技術(shù)上具有可行性,但對(duì)于再通治療安全性及有效性尚需大樣本的臨床研究證據(jù)支持。
[Abstract]:Objective: To investigate the symptomatic vertebral basilar artery stenosis and occlusion of intracranial lesions underwent endovascular treatment of feasibility, safety, effectiveness, the main treatment of perioperative complications after endovascular stent restenosis, and other reasons. Materials and methods: the study included in the January 2014 to November 2016 in the hospital neurology department of No.1 Hospital of Jilin University after 68 circulation ischemia patients, patients underwent DSA examination found intracranial vertebrobasilar system has the responsibility of more than 70% vascular stenosis or occlusion underwent endovascular treatment as the research object. Collect patient admission data and risk factors and other information. Preoperative administration of dual antiplatelet aggregation therapy (aspirin at least 3-5d 100 mg/d+ clopidogrel 75 mg/d), preoperative administration of continuous intravenous infusion of nimodipine prevent vasospasm. According to the target lesion vessels of the selection of support or Balloon dilatation therapy, postoperative low molecular weight heparin 40 mg/bid, 3D; dual antiplatelet therapy (aspirin 100mg/d+ and clopidogrel 75 mg/d) 6 months after long-term single antiplatelet therapy. And telephone or ultrasound. Results: the follow-up of patients with symptomatic vertebrobasilar artery stenosis of intracranial stent for the treatment of 58 cases, 50 males, 8 females. Age 59.14 + 9.15 years. Factors into the group of patients with stroke and prognosis. Including 23 cases of diabetes before surgery, only 8 cases (34.8%) of glycosylated hemoglobin 7.0%. symptoms of 44 cases of dizziness (75.9%), of which only 22 cases of dizziness (37.9%) paralysis 17. (29.3% cases), 6 cases of paresthesia (10.3%), 10 cases (17.2%), speech disorder in 9 cases of visual impairment (15.5%). Around the major complication of surgery 7 cases (12.8%), the target blood vessel of acute thrombosis in 4 cases, 1 cases of subarachnoid hemorrhage, 2 cases of perforating artery stent lesions. 鐙獎(jiǎng)8渚，

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