本文選題：頸動(dòng)脈 + 支架�。� 參考：《鄭州大學(xué)》2016年博士論文

【摘要】：第一部分:改良橈動(dòng)脈路徑頸動(dòng)脈支架成形術(shù)的臨床研究研究背景及目的股動(dòng)脈是CAS的常規(guī)路徑,但是股動(dòng)脈穿刺并發(fā)癥高,舒適度差,且部分患者經(jīng)股動(dòng)脈手術(shù)困難或手術(shù)失敗;傳統(tǒng)經(jīng)橈動(dòng)脈路徑CAS手術(shù)操作繁瑣,成功率低,并發(fā)癥高;本研究通過探討改良經(jīng)橈動(dòng)脈路徑CAS的可行性及安全性,總結(jié)改良經(jīng)橈動(dòng)脈路徑CAS的注意事項(xiàng)、技術(shù)要點(diǎn),器械及技術(shù)改進(jìn),為CAS開拓一個(gè)新的手術(shù)路徑。材料與方法回顧性分析2015年9月至2016年6月鄭州大學(xué)人民醫(yī)院腦血管病介入治療中心46例患者經(jīng)橈動(dòng)脈路徑行CAS臨床資料,分析技術(shù)成功率及圍手術(shù)其心腦血管及穿刺并發(fā)癥。回顧性分析2015年1月至2015年12月鄭州大學(xué)人民醫(yī)院腦血管病介入治療中心46例經(jīng)股動(dòng)脈行CAS患者臨床及手術(shù)資料,對(duì)比分析其與經(jīng)橈動(dòng)脈行CAS射線投射時(shí)間差異�；仡櫺苑治�2014年1月至2015年12月鄭州大學(xué)人民醫(yī)院腦血管病介入治療中心20例經(jīng)股動(dòng)脈路徑CAS治療Ⅲ型主動(dòng)脈弓合并右側(cè)頸動(dòng)脈狹窄及牛角型主動(dòng)脈弓合并左側(cè)頸動(dòng)脈狹窄患者的臨床及手術(shù)資料,對(duì)比分析其與經(jīng)橈動(dòng)脈CAS射線投射時(shí)間差異。結(jié)果所有患者均經(jīng)右側(cè)橈動(dòng)脈入路,均經(jīng)橈動(dòng)脈進(jìn)行腦血管造影,成功率100%,指引導(dǎo)管到位成功率98%,手術(shù)成功率98%。無嚴(yán)重心腦血管事件發(fā)生。1例患者出現(xiàn)橈動(dòng)脈無癥狀性閉塞。經(jīng)橈動(dòng)脈路徑CAS射線投照時(shí)間與經(jīng)股動(dòng)脈路徑CAS射線投照時(shí)間對(duì)比分析差異無統(tǒng)計(jì)學(xué)意義(P=0.376)。Ⅲ型主動(dòng)脈弓合并右側(cè)頸動(dòng)脈狹窄及牛角型主動(dòng)脈弓合并左側(cè)頸動(dòng)脈狹窄患者經(jīng)橈動(dòng)脈路徑CAS術(shù)中射線投射時(shí)間[(9.23±1.02)min]較經(jīng)股動(dòng)脈入路患者[(11.51±1.39)min]射線投照時(shí)間明顯減少,差異有統(tǒng)計(jì)學(xué)意義(P=0.001)。結(jié)論改良經(jīng)橈動(dòng)脈路徑CAS手術(shù)成功率高,并發(fā)癥低是安全、可行的。經(jīng)橈動(dòng)脈路徑CAS不增加手術(shù)難度;且克服了因股動(dòng)脈、髂動(dòng)脈、主動(dòng)脈閉塞或嚴(yán)重迂曲等原因?qū)AS的限制,大大擴(kuò)展了CAS的適應(yīng)癥;對(duì)于Ⅲ型主動(dòng)脈弓合并右側(cè)頸動(dòng)脈狹窄及牛角型主動(dòng)脈弓合并左側(cè)頸動(dòng)脈狹窄患者經(jīng)橈動(dòng)脈行CAS可減低手術(shù)難度,縮短手術(shù)時(shí)間及降低手術(shù)風(fēng)險(xiǎn)。第二部分:主動(dòng)脈弓形態(tài)對(duì)頸動(dòng)脈支架成形術(shù)入路選擇的影響一530例主動(dòng)脈弓DSA影像分析背景及目的主動(dòng)脈弓及其分支血管是頸動(dòng)脈支架成形的必經(jīng)之路,被稱為“腦前血管”,其分型及分支變異對(duì)頸動(dòng)脈支架成形術(shù)有重大影響,本研究通過數(shù)字減影造影(DSA)對(duì)成人主動(dòng)脈弓及其分支血管進(jìn)行分析,觀察主動(dòng)脈弓分型及其分支的相關(guān)變異,并分析主動(dòng)脈弓分型與性別、年齡、高血壓、糖尿病、高脂血癥等因素之間的相關(guān)性。旨在為頸動(dòng)脈支架成形術(shù)的開展提供幫助。材料與方法分析本中心2015年1月-2016年12月的530例主動(dòng)脈弓數(shù)字剪影血管造影(DSA)患者的影像資料及臨床資料。男性347例(65.5%),女性183例(34.5%);年齡18~83歲,平均年齡58.3±11.7歲。主動(dòng)脈弓分支變異進(jìn)行分類方法采取:以De Garis的分型法與Mc Donald、Anson的分型法相結(jié)合的方法進(jìn)行分型。主動(dòng)脈弓分型采取:測(cè)量主動(dòng)脈弓頂?shù)筋^臂干的垂直距離,以優(yōu)勢(shì)側(cè)頸總動(dòng)脈直徑為參照標(biāo)準(zhǔn)(多以左側(cè)頸總動(dòng)脈為標(biāo)準(zhǔn)),1倍以內(nèi)的是Ⅰ型,大于2倍者為Ⅲ型,距離介于1~2倍之間為Ⅱ型主動(dòng)脈弓。并統(tǒng)計(jì)分析主動(dòng)脈弓分型情況。采用SPSS 18.0軟件,所有患者的人群基本特征、臨床特點(diǎn)及主動(dòng)脈弓型經(jīng)采集后進(jìn)入數(shù)據(jù)庫(kù),統(tǒng)計(jì)方法采用采用單變量分析方法,有統(tǒng)計(jì)學(xué)意義的指標(biāo)進(jìn)行Logistic檢驗(yàn),差異具有統(tǒng)計(jì)學(xué)意義為P0.05。結(jié)果主動(dòng)脈弓分型:530例患者中Ⅰ型231例43.6%(男143例,女88例),Ⅱ型167例31.5%(男105例,女62例),Ⅲ型132例24.9%(男99例,女33例)。青年組(≤44歲)95例,Ⅰ型69例,Ⅱ型19例,Ⅲ型7例,其中30歲以下患者9例均為Ⅰ型;中年組(45~59歲)184例,Ⅰ型99例,Ⅱ型54例,Ⅲ型31例;老年組(≥60歲)251例,Ⅰ型63例,Ⅱ型94例,Ⅲ型94例。單因素分析有統(tǒng)計(jì)學(xué)意義的年齡、冠心病、甘油三酯、高密度脂蛋白膽固醇4項(xiàng)指標(biāo)進(jìn)行多因素Logistic回歸分析,結(jié)果顯示:年齡是Ⅲ型主動(dòng)脈弓的獨(dú)立危險(xiǎn)因素。主動(dòng)脈弓上分支變異:530例患者中正常3干440例(81.1%),主動(dòng)脈弓及其分支變異LCCA與BCT共干、LSCA:37例;LCCA發(fā)自BCT、LSCA:29例;BCT、LCCA、LVA、LSCA:18例;LCCA與RCCA共干、RSCA、LSCA:2例;無BCT、RCCA、LCCA、LVA、LSCA、迷走RSCA最后發(fā)出:2例;LCCA與RCC共干發(fā)自BCT、LSCA:1例,主動(dòng)脈弓分支變異發(fā)生率男女組間差異無統(tǒng)計(jì)學(xué)意義(P㧐0.05)。結(jié)論老年人群中Ⅲ型主動(dòng)脈弓比例顯著升高;主動(dòng)脈弓及其分支變異發(fā)生率相對(duì)較高,最常見的是左側(cè)頸總動(dòng)脈與頭臂干共干/共同開口;Ⅲ型主動(dòng)脈弓及主動(dòng)脈弓分支變異患者經(jīng)股動(dòng)脈行頸動(dòng)脈支架成形手術(shù)難度及風(fēng)險(xiǎn)均明顯增大,而經(jīng)橈動(dòng)脈路徑則相對(duì)簡(jiǎn)易,需引起神經(jīng)介入醫(yī)生術(shù)前高度關(guān)注。
[Abstract]:The first part: the clinical research background and objective femoral artery of modified radial artery pathway carotid artery stenting is the routine route of CAS, but the femoral artery puncture complications are high, the comfort is poor, and some patients are difficult to operate through the femoral artery or the operation failure. The traditional radial artery route CAS operation is tedious, the success rate is low, and the complications are high. In this study, the feasibility and safety of the modified transradial artery pathway CAS were discussed, and the improvement of CAS by radial artery pathway was summarized, and the technical points, instruments and techniques were improved to open up a new surgical path for CAS. The materials and methods were reviewed for the interventional treatment of cerebrovascular disease in the people's Hospital of Zhengzhou University from September 2015 to June 2016. The clinical data of 46 patients with CAS from the radial artery were carried out to analyze the success rate and the peri operative cardiovascular and puncture complications. The clinical and surgical data of 46 patients with CAS in the interventional therapy center of the cerebral vascular disease, Zhengzhou University, from January 2015 to December 2015, were retrospectively analyzed and compared with the radial artery. The differences in the time of CAS ray projection. A retrospective analysis of the clinical and surgical data of 20 cases of cerebral vascular disease interventional therapy center in the people's Hospital of Zhengzhou University from January 2014 to December 2015 with the treatment of the femoral artery pathway CAS in the treatment of type III aortic arch with right carotid artery stenosis and angular aortic arch with left carotid artery stenosis. The CAS ray projection time of the radial artery was different from that of the radial artery. All the patients underwent cerebral angiography through the radial artery through the right radial artery. The success rate was 100%, the success rate of the catheter was 98%, the success rate of the operation was 98%. without serious cardio cerebral vascular events and the asymptomatic occlusion of the radial artery occurred in the.1 patients. The CAS ray through the radial artery pathway There was no significant difference between the time of exposure and the time of CAS ray exposure through the femoral artery (P=0.376). Type III aortic arch combined with right carotid artery stenosis and the radiographic projection time of the left carotid artery stenosis in patients with left carotid artery stenosis via the radial artery path CAS [(9.23 + 1.02) min] compared with the femoral artery approach patients [11.51] The time of min] ray exposure decreased significantly (P=0.001), and the difference was statistically significant (P=0.001). Conclusion it is safe and feasible to improve the successful rate of CAS operation through the radial artery path, and it is feasible. The route of the radial artery path does not increase the difficulty of operation; and it overcomes the limitation of the CAS because of the femoral and iliac arteries, the aorta occlusion or severe tortuosity. Extension of the indications of CAS; for the type III aortic arch with right carotid artery stenosis and the angular aortic arch with left carotid artery stenosis patients with left carotid artery stenosis, CAS can reduce the difficulty of operation, shorten the operation time and reduce the risk of operation. Second part: the effect of the aortic arch shape on the choice of carotid artery stenting approach is 530 The aortic arch DSA image analysis background and objective aortic arch and its branch vessel is the only way of carotid artery stenting. It is called "anterior cerebral vascular". Its classification and branch variation have great influence on carotid artery stenting. This study analyzed adult aortic arch and its branch vessels by digital subtraction angiography (DSA). To observe the correlation between aortic arch classification and its branches, and analyze the correlation between aortic arch classification and sex, age, hypertension, diabetes, hyperlipidemia and other factors. The purpose is to provide help for the development of carotid artery stenting. Materials and methods were analyzed in 530 cases of aortic arch digital silhouette in December -2016 January 2015. Angiography (DSA) patients' imaging data and clinical data. Male 347 (65.5%), female 183 cases (34.5%); age 18~83 years, average age 58.3 + 11.7 years old. Aortic arch branch variation was classified by classification of De Garis typing with Mc Donald, Anson typing method. Aortic arch classification was taken: Measurement The vertical distance from the top of the aortic arch to the head of the brachial trunk, with the diameter of the dominant common carotid artery as the reference standard (more than the left common carotid artery as the standard), was type I within 1 times, the type of type I was type III more than 2 times, and the distance between 1~2 times was type II aortic arch. The aortic arch classification was statistically analyzed. SPSS 18 software was used in all patients. The basic features, clinical characteristics and the aortic arch type were collected into the database. Statistical methods were used for Logistic test with statistically significant indexes. The difference was statistically significant for the P0.05. result of aortic arch typing: 530 cases were type I 231 cases 43.6% (male 143, female 88), and type II 167 cases 31.5% (3 cases). Male 105, female 62 cases, type III 132 cases 24.9% (men 99 cases, 33 cases). Young group (< < 44 years old) 95 cases, type I 69 cases, 19 cases, 19, 7 cases, among them 30 years, 9 cases are all type I; middle age group (45~59 years) of 184 cases, type I cases, type III cases, type III cases, type I cases, type I cases, type III cases, type III cases. The statistically significant age, coronary heart disease, triglyceride, and high density lipoprotein cholesterol were analyzed by multiple factor Logistic regression analysis. The results showed that age was an independent risk factor for the type III aortic arch. The branch variation in the aortic arch: 440 cases of normal 3 dry (81.1%) in 530 cases, the aortic arch and its branch variation LCCA and BCT, LS CA:37 cases; LCCA from BCT, LSCA:29 cases; BCT, LCCA, LVA, LSCA:18 cases; LCCA and RCCA co dry, RSCA, LSCA:2 examples; there are 2 cases; there is no statistical difference between male and female group of aortic arch branch variation (0.05). Conclusion the type III aortic arch in the elderly population The incidence of the aortic arch and its branch variation is relatively high, the most common is the common trunk / joint opening of the left common carotid artery and the head arm, and the degree of difficulty and risk of the carotid artery stenting in the patients with the type III aortic arch and the aortic arch branch is significantly increased, while the radial artery path is relatively simple. It is necessary to arouse the attention of the doctor before the operation of the nerve.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R743.3

【相似文獻(xiàn)】

中國(guó)期刊全文數(shù)據(jù)庫(kù) 前10條

1 魏春麗;先天性多動(dòng)脈狹窄一例誤診分析[J];實(shí)用心腦肺血管病雜志;2003年01期

2 趙翠松;覃英雪;梁冰;徐曼丹;雷麗華;;顱內(nèi)外動(dòng)脈狹窄血管內(nèi)支架置入術(shù)病人的護(hù)理[J];廣西醫(yī)科大學(xué)學(xué)報(bào);2007年02期

3 張志勇;李慎茂;朱鳳水;繆中榮;凌鋒;;短暫性腦缺血發(fā)作與顱內(nèi)-外動(dòng)脈狹窄的關(guān)系[J];中國(guó)腦血管病雜志;2008年01期

4 趙進(jìn)委;惲文偉;蔣國(guó)民;王凱;;粥樣硬化性腎動(dòng)脈狹窄與顱內(nèi)-外動(dòng)脈狹窄的關(guān)系[J];介入放射學(xué)雜志;2009年07期

5 顧蘇兵;施天明;林高平;王奕琪;張劍梅;張文亞;郭舜源;;腦梗死患者顱內(nèi)和頸部動(dòng)脈狹窄的分布及特點(diǎn)[J];中國(guó)臨床神經(jīng)科學(xué);2010年04期

6 肖玲;張遙;呂健;;中青年短暫性腦缺血發(fā)作患者血漿同型半胱氨酸水平與顱內(nèi)外動(dòng)脈狹窄的相關(guān)性研究[J];黑龍江醫(yī)學(xué);2011年02期

7 李軍;張祥建;;短暫性腦缺血發(fā)作與顱內(nèi)、外動(dòng)脈狹窄之間的關(guān)系探討[J];腦與神經(jīng)疾病雜志;2013年05期

8 許雅萍;;椎基動(dòng)脈狹窄治驗(yàn)二則[J];浙江中醫(yī)學(xué)院學(xué)報(bào);1993年03期

9 來穎，楊海山，李玉林;實(shí)驗(yàn)性股動(dòng)脈狹窄和成形術(shù)[J];白求恩醫(yī)科大學(xué)學(xué)報(bào);1995年01期

10 蘆軍;趙偉麗;孫曉紅;崔其福;;動(dòng)態(tài)動(dòng)脈硬化指數(shù)與顱內(nèi)、外動(dòng)脈狹窄的相關(guān)性研究[J];實(shí)用醫(yī)學(xué)雜志;2014年05期

中國(guó)重要會(huì)議論文全文數(shù)據(jù)庫(kù) 前10條

1 楊銘;馬廉亭;張新元;潘力;黃成;;顱內(nèi)動(dòng)脈粥樣硬化性狹窄的支架成型術(shù)[A];中華醫(yī)學(xué)會(huì)神經(jīng)外科學(xué)分會(huì)第九次學(xué)術(shù)會(huì)議論文匯編[C];2010年

2 王大明;劉加春;陸軍;;癥狀性頭頸部動(dòng)脈狹窄老年患者的臨床干預(yù)研究[A];中國(guó)醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)第二屆全國(guó)代表大會(huì)論文匯編[C];2007年

3 王子亮;李天曉;翟水亭;曾會(huì)存;孟艷莉;白衛(wèi)星;劉建;;癥狀性椎基動(dòng)脈狹窄經(jīng)皮腔內(nèi)支架成形的初步研究[A];河南省第二屆腫瘤微創(chuàng)治療學(xué)術(shù)大會(huì)暨新鄉(xiāng)抗癌協(xié)會(huì)腫瘤微創(chuàng)治療專業(yè)委員會(huì)成立大會(huì)、河南省胸部疾病影像診斷與治療新進(jìn)展研討會(huì)暨新鄉(xiāng)市影像診斷新進(jìn)展與新技術(shù)研討會(huì)論文匯編[C];2007年

4 陳茂華;陸川;孫軍;;后循環(huán)動(dòng)脈狹窄支架置入前后血流動(dòng)力學(xué)變化的研究[A];第三屆江浙滬三地老年醫(yī)學(xué)高峰論壇暨2012年浙江省老年醫(yī)學(xué)學(xué)術(shù)年會(huì)論文集[C];2012年

5 陳茂華;陸川;孫軍;;后循環(huán)動(dòng)脈狹窄支架置入前后血流動(dòng)力學(xué)變化的研究[A];第三屆江浙滬三地老年醫(yī)學(xué)高峰論壇暨2012年浙江省老年醫(yī)學(xué)學(xué)術(shù)年會(huì)論文集[C];2012年

6 樊瑜波;蔣文濤;鄧小燕;;動(dòng)脈狹窄、搭橋的血流動(dòng)力學(xué)三維數(shù)值模擬[A];第十次中國(guó)生物物理學(xué)術(shù)大會(huì)論文摘要集[C];2006年

7 裴詠楨;徐格林;朱武生;劉新峰;;缺血性腦血管病患者顱內(nèi)外動(dòng)脈狹窄的年齡分布特征[A];第九次全國(guó)神經(jīng)病學(xué)學(xué)術(shù)大會(huì)論文匯編[C];2006年

8 繆中榮;;癥狀性顱內(nèi)外動(dòng)脈狹窄介入治療適應(yīng)證選擇和風(fēng)險(xiǎn)評(píng)估[A];中國(guó)醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)第四屆全國(guó)代表大會(huì)論文匯編[C];2009年

9 吳鋼;;顱內(nèi)動(dòng)脈粥樣硬化性狹窄的TCD定性與定量診斷[A];第七屆全國(guó)顱腦及頸動(dòng)脈超聲學(xué)術(shù)會(huì)議論文匯編[C];2007年

10 范秀玉;;頸部大動(dòng)脈狹窄介入治療前后腦血流改變[A];中華醫(yī)學(xué)會(huì)第十次全國(guó)超聲醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2009年

中國(guó)重要報(bào)紙全文數(shù)據(jù)庫(kù) 前4條

1 記者 鄧國(guó)慶;巴西科學(xué)家發(fā)現(xiàn)心動(dòng)脈狹窄的病因[N];科技日?qǐng)?bào);2002年

2 新;放射治療動(dòng)脈狹窄[N];醫(yī)藥經(jīng)濟(jì)報(bào);2000年

3 記者 劉冬梅 通訊員 李哲 周寧;膝下動(dòng)脈狹窄患者免遭截肢之苦[N];天津日?qǐng)?bào);2006年

4 ;技術(shù)創(chuàng)先 服務(wù)百姓[N];泰安日?qǐng)?bào);2011年

中國(guó)博士學(xué)位論文全文數(shù)據(jù)庫(kù) 前6條

1 樊新穎;癥狀性顱內(nèi)外動(dòng)脈狹窄/閉塞特征分析和遺傳易感性的研究[D];南京大學(xué);2016年

2 許崗勤;改良橈動(dòng)脈路徑頸動(dòng)脈支架成形術(shù)的臨床研究[D];鄭州大學(xué);2016年

3 邢廣羽;短暫性腦缺血發(fā)作的概念、病因及臨床特點(diǎn)研究[D];中國(guó)人民解放軍軍醫(yī)進(jìn)修學(xué)院;2008年

4 單厚昌;動(dòng)脈狹窄度與現(xiàn)有疾病證候檢驗(yàn)指標(biāo)相關(guān)性及證候判別的數(shù)學(xué)模型構(gòu)建研究[D];湖南中醫(yī)藥大學(xué);2008年

5 王大明;癥狀性頭頸部動(dòng)脈狹窄老年患者的臨床干預(yù)與相關(guān)實(shí)驗(yàn)研究[D];中國(guó)人民解放軍軍醫(yī)進(jìn)修學(xué)院;2007年

6 李建;Wingspan支架治療癥狀性顱內(nèi)粥樣硬化性動(dòng)脈狹窄[D];第四軍醫(yī)大學(xué);2011年

中國(guó)碩士學(xué)位論文全文數(shù)據(jù)庫(kù) 前10條

1 劉文虎;頭頸部動(dòng)脈狹窄和斑塊與急性腦梗死進(jìn)展及復(fù)發(fā)的相關(guān)性分析[D];河北聯(lián)合大學(xué);2014年

2 張廣玉;顱內(nèi)外重度動(dòng)脈狹窄患者藥物治療與血管內(nèi)支架植入治療卒中復(fù)發(fā)評(píng)估[D];河北醫(yī)科大學(xué);2015年

3 王峻峰;90歲以上缺血性卒中患者顱內(nèi)外動(dòng)脈狹窄的特點(diǎn)研究[D];第三軍醫(yī)大學(xué);2015年

4 張磊;128層螺旋CT血管造影評(píng)價(jià)癥狀性主動(dòng)脈弓以上動(dòng)脈狹窄的價(jià)值研究[D];青島大學(xué);2016年

5 孟偉建;CTP在頸部動(dòng)脈狹窄支架成形術(shù)前的評(píng)估價(jià)值[D];河北醫(yī)科大學(xué);2016年

6 李彌彌;動(dòng)脈粥樣硬化性腦梗死患者顱內(nèi)外動(dòng)脈狹窄與載脂蛋白A1、B的相關(guān)性分析[D];福建醫(yī)科大學(xué);2013年

7 榮艷紅;缺血性腦血管病動(dòng)脈狹窄的病因分析和基礎(chǔ)研究[D];天津醫(yī)科大學(xué);2007年

8 凌冰;顱內(nèi)外動(dòng)脈狹窄的分布特點(diǎn)及相關(guān)危險(xiǎn)因素分析[D];暨南大學(xué);2012年

9 田佳楠;青年腦梗塞顱內(nèi)外動(dòng)脈狹窄危險(xiǎn)因素的分析[D];吉林大學(xué);2013年

10 金亭延;高同型半胱氨酸血癥與顱內(nèi)外動(dòng)脈狹窄的關(guān)系[D];吉林大學(xué);2013年

，

本文編號(hào)：2117174