【摘要】：背景及目的缺血性腦血管病是臨床常見的一種血管疾病,主要發(fā)生在老年人。隨著我國人口進(jìn)入老齡化,缺血性腦血管病的發(fā)病率越來越高,且有年輕化的趨勢。動脈粥樣硬化引起的血管狹窄是引起腦缺血發(fā)作和卒中的重要原因。近年來,對于缺血性腦血管病的治療研究突飛猛進(jìn),無論是傳統(tǒng)的藥物治療還是新開展的介入治療都取得了巨大進(jìn)步,尤其是介入治療方面,人們吸取了冠脈缺血性病變、外周血管病變以及出血性腦血管介入治療的經(jīng)驗(yàn),在很短時間內(nèi)無論在技術(shù)的可行性方面,還是臨床療效方面都取得了突破性進(jìn)展。隨著神經(jīng)影像學(xué)、導(dǎo)管技術(shù)和材料、計算機(jī)等學(xué)科的迅速發(fā)展,神經(jīng)介入技術(shù)日臻成熟,目前已成為腦血管病的重要治療方法,并逐漸發(fā)展成為一門獨(dú)立的學(xué)科。缺血性腦血管病介入治療是指研究利用血管內(nèi)導(dǎo)管操作技術(shù),在計算機(jī)控制的數(shù)字減影血管造影(digital subtraction angiography, DSA)系統(tǒng)的支持下,對累及人體神經(jīng)系統(tǒng)血管的病變進(jìn)行診斷和治療,達(dá)到栓塞、溶解、擴(kuò)張、成形等治療目的的一種臨床醫(yī)學(xué)科學(xué)。缺血性腦血管病的神經(jīng)介入診斷及治療,能夠大大減少患者痛苦及致殘率,減輕家庭及社會負(fù)擔(dān),擺脫缺血性腦血管病發(fā)病率高、反復(fù)發(fā)病的怪圈,以及單一用藥物治療缺血性腦血管病的歷史。缺血性腦血管病介入治療技術(shù)是近二十多年迅速發(fā)展起來的新興學(xué)科。雖然這一技術(shù)在腦血管病中的應(yīng)用時間較短,發(fā)展卻非常迅速。從治療方式、患者篩選、術(shù)中術(shù)后用藥、并發(fā)癥防治等諸多方面對血管內(nèi)介入技術(shù)在腦血管病中的臨床應(yīng)用進(jìn)行了系統(tǒng)規(guī)范。在放射影像引導(dǎo)下,借助導(dǎo)管、導(dǎo)絲、擴(kuò)張球囊、支架等卓越材料進(jìn)行的血管內(nèi)微創(chuàng)手術(shù),可使過去認(rèn)為難治、不能治的閉塞或重度狹窄的腦供血動脈管腔重塑并基本恢復(fù)正常,為缺血性腦血管病的治療開辟了新的治療途徑。由于創(chuàng)傷小、安全性高、療效好,已經(jīng)成為醫(yī)學(xué)界一顆璀璨的明星,越來越引起人們的重視。目前缺血性腦血管病介入手術(shù)有：急性腦梗死超選擇接觸性動脈內(nèi)溶栓術(shù)、顱內(nèi)靜脈竇血栓介入溶栓術(shù)、顱內(nèi)動脈狹窄支架成形術(shù)、顱外腦供血動脈(頸總動脈、頸內(nèi)動脈、椎動脈、鎖骨下動脈、無名動脈)狹窄支架成形術(shù)。而目前DSA已經(jīng)成為缺血性腦血管病早期診斷中最重要的方法,在PTAS術(shù)前指導(dǎo)和術(shù)后評價中具有重要的價值；PTAS是治療缺血性腦血管病顱內(nèi)外腦供血動脈狹窄或閉塞新的有效治療方法,微創(chuàng)、安全、有效,近期療效肯定。熟練而規(guī)范的操作是支架置入技術(shù)成功的關(guān)鍵,在嚴(yán)格掌握適應(yīng)癥和有經(jīng)驗(yàn)的醫(yī)生操作下治療是安全的。目前狀況,1、在顱外段頸動脈粥樣硬化性狹窄,常用的治療方法有藥物治療、手術(shù)治療及血管內(nèi)介入治療,其中,手術(shù)治療包括動脈內(nèi)膜剝脫術(shù)(carotid endarterectomy, CEA)、顱內(nèi)外血管搭橋術(shù)等,血管內(nèi)介入治療包括血管成形和支架置入術(shù)(carotid artery stenting, CAS)、血管內(nèi)膜旋切術(shù)、機(jī)械輔助的血管再通術(shù)等。雖在外科手術(shù)治療頸動脈粥樣硬化性狹窄的方法中,動脈內(nèi)膜剝脫術(shù)操作相對簡單,療效已被50多年的臨床實(shí)踐所驗(yàn)證,但我國CEA由于種種原因在各級醫(yī)院神經(jīng)外科開展非常有限,且目前幾項(xiàng)大的臨床隨機(jī)研究都沒有顯示出CAS比CEA風(fēng)險更高,因此CAS可以成為頸動脈粥樣硬化性狹窄治療的主要方法之一；2、在顱外段椎動脈粥樣硬化性狹窄,規(guī)范內(nèi)科藥物治療療效并不明確,而外科手術(shù)治療并發(fā)癥發(fā)生率較高,其遠(yuǎn)期效果也遠(yuǎn)不如內(nèi)膜切除術(shù)治療頸動脈狹窄,雖現(xiàn)階段支持顱外段椎動脈狹窄血管成形術(shù)治療的循證醫(yī)學(xué)證據(jù)尚不充分,但由于藥物治療及外科手術(shù)的局限性,藥物治療后仍有缺血事件發(fā)生的患者可考慮施行血管內(nèi)介入治療,且椎動脈動脈粥樣硬化性狹窄血管成形術(shù)及支架植入術(shù)正在成為研究的熱點(diǎn)；3、在無名動脈或鎖骨下動脈狹窄,目前對于藥物治療無效的癥狀性動脈粥樣硬化性狹窄或閉塞的患者,隨著血管內(nèi)介入治療技術(shù)和材料的發(fā)展,通過血管內(nèi)介入方法治療無名動脈或鎖骨下動脈狹窄或閉塞性病變具有創(chuàng)傷小、術(shù)后恢復(fù)快、臨床療效滿意等優(yōu)點(diǎn),已逐步取代動脈旁路移植術(shù),成為首選的治療手段；4、在顱內(nèi)動脈粥樣硬化性狹窄的治療,目前的觀點(diǎn)認(rèn)為對于癥狀性顱內(nèi)動脈粥樣硬化性狹窄患者,首先應(yīng)積極進(jìn)行優(yōu)化的藥物治療,對于藥物治療無效的患者,如臨床狀況允許、側(cè)支循環(huán)差、狹窄程度≥70%,可以考慮血管內(nèi)介入治療；5、在急性缺血性卒中救治方面,目前唯一被循證醫(yī)學(xué)證實(shí)有效的治療方法就是靜脈溶栓,但靜脈溶栓具有時間窗短、溶通率低、再閉塞率高、有一定出血風(fēng)險等缺點(diǎn),而血管內(nèi)動脈溶栓、機(jī)械取栓裝置以及動脈溶栓聯(lián)合機(jī)械取栓方法的臨床應(yīng)用,進(jìn)一步擴(kuò)展了急性缺血性卒中的治療時間窗、再通率、減少出血風(fēng)險；6、顱內(nèi)靜脈竇血栓介入治療,目前缺乏有力的循證醫(yī)學(xué)證據(jù)表明顱內(nèi)靜脈竇血栓患者需采用血管內(nèi)介入治療,但經(jīng)規(guī)范抗凝及靜脈溶栓無效的患者,可考慮血管內(nèi)治療,包括靜脈竇內(nèi)接觸性溶栓、機(jī)械性碎栓、靜脈竇內(nèi)支架植入術(shù)。在國際上,有關(guān)缺血性腦血管病介入治療的指南每年都有較大的更新,每年都有新技術(shù)、新材料、新療法和新的大型臨床研究報道,而中國擁有世界上最龐大的腦血管病患者群體,但我們目前還沒有開展缺血性腦血管病介入治療的大型臨床對照研究,缺乏針對中國人缺血性腦血管病介入治療的循證醫(yī)學(xué)Ⅰ、Ⅱ級證據(jù)。同時,我國在制定缺血性腦血管病介入治療的指南時,還只能參考國外研究的結(jié)果。但需要注意的是,由于生活方式、經(jīng)濟(jì)文化和人種的不同,腦血管病的發(fā)病特點(diǎn)、危險因素和遠(yuǎn)期預(yù)后可能會存在差異,顱內(nèi)外動脈粥樣硬化發(fā)生的部位、病理特點(diǎn)也可能會存在差異,最終可能影響患者血管內(nèi)介入治療的獲益性不同。此外,患者的社會經(jīng)濟(jì)狀況還可能會影響介入器材的選擇和術(shù)后是否能堅持用藥。因此開展腦血管病介入治療時,要充分考慮這些因素,不能完全照搬西方的研究結(jié)果。到目前為止,血管內(nèi)介入技術(shù)在西方國家經(jīng)歷了多年的發(fā)展,已建立了系統(tǒng)的介入技術(shù)培訓(xùn)機(jī)制,形成了比較完善的介入醫(yī)師資質(zhì)認(rèn)證體系,加上醫(yī)療保險系統(tǒng)的監(jiān)督和制衡作用,使血管內(nèi)介入技術(shù)步入了良性發(fā)展的軌道。而在我國,盡管神經(jīng)血管介入技術(shù)的研發(fā)和臨床應(yīng)用取得了長足進(jìn)展,某些領(lǐng)域可能還處于世界領(lǐng)先的地位,但由于技術(shù)整體開展時間短,缺乏完善的規(guī)章制度,沒有系統(tǒng)的人員培訓(xùn)和資質(zhì)認(rèn)證機(jī)制,因此,這一技術(shù)往往成為行業(yè)內(nèi)外爭論的焦點(diǎn)。要解決這一問題,需要不同的從業(yè)人員聯(lián)合起來,建立規(guī)范的腦血管病介入技術(shù)培訓(xùn)機(jī)制,制定可行的介入醫(yī)師資格認(rèn)證體系,使我國的神經(jīng)血管介入技術(shù)朝著合理、有序的方向發(fā)展,造福廣大患者。本文探討數(shù)字減影血管造影(digital subtraction angiography, DSA)對缺血性腦血管病的病因早期確診的優(yōu)越性及診斷價值。同時探討經(jīng)皮腔內(nèi)支架成形術(shù)(percutaneous transluminal angioplasty and stenting, PTAS)在缺血性腦血管病治療中的適應(yīng)癥的選擇、技術(shù)操作、療效和并發(fā)癥,對比分析手術(shù)前患者臨床癥狀的改變、腦血流灌注的改善程度,初步探討PTAS術(shù)的安全性和有效性；總結(jié)PTAS治療100例患者的療效及并發(fā)癥的發(fā)生與防治。方法回顧性分析我院神經(jīng)內(nèi)外科2012年8月至2013年5月開展缺血性腦血管病介入治療期間住院的缺血性腦血管病患者125例,所有患者均進(jìn)行頸部彩色多普勒血流顯像(color Doppler flow imaging, CDFI)、經(jīng)顱多普勒超聲(transcranial Doppler, TCD)、電子計算機(jī)體層掃描(computerized tomography,CT)、CT血管造影(computed tomography angiography, CTA)、CT灌注成像(computed tomography Perfusion, CTP)、核磁共振成像magnetic resonance imaging, MRI)、彌散加權(quán)成像(diffusion weighted imaging, D WI)、核磁共振血管造影(magnetic resonance angiography, MRA)、DSA檢查,對比不同方法對患者的診斷價值。明確弓上頭頸部大血管(無名動脈、鎖骨下動脈、頸動脈及椎動脈顱外段)和顱內(nèi)血管狹窄部位、程度并進(jìn)行術(shù)前評價,依據(jù)缺血性腦血管病介入治療的適應(yīng)證和禁忌證篩選了100例患者的118支血管進(jìn)行PTAS治療,均成功完成支架置入；共置入支架119枚。術(shù)后即刻造影評價并隨訪6個月-1年,對DSA的檢查結(jié)果、介入治療的療效和并發(fā)癥進(jìn)行臨床分析。結(jié)果125例患者通過DSA檢查1250條血管發(fā)現(xiàn)121例患者有血管狹窄,查出病變血管共有301支。其中頸內(nèi)動脈C1段73支,椎動脈V1段64支,鎖骨下動脈38支,無名動脈4支,大腦中動脈43支、基底動脈33支、椎動脈V4段20支、頸內(nèi)動脈C4段9支、C6段11支、C7段6支。血管閉塞18支,狹窄在70%、99%之間的142支,狹窄程度在50-69%之間的57支,狹窄程度低于50%的84支。血管病變程度：使用DSA發(fā)現(xiàn)患者的病變血管支數(shù)最多,與多層螺旋CTA及MRA檢查比較有統(tǒng)計學(xué)差異,p0.05；最終經(jīng)過嚴(yán)格篩選出100例癥狀性動脈粥樣硬化性重度動脈狹窄的患者,均符合介入手術(shù)適應(yīng)癥,共有118支病變血管,共植入支架119枚。手術(shù)成功率100%。患者術(shù)后血管狹窄改善明顯；癥狀明顯緩解或消失；神經(jīng)功能狀況改善；前向血流及腦灌注明顯改善。圍手術(shù)期,13例TIA患者和8例表現(xiàn)有明顯頭昏的患者癥狀即刻消失或好轉(zhuǎn)；12例行頸內(nèi)動脈支架植入術(shù)后原來難以控制的高血壓病明顯改善。1例患者頸內(nèi)動脈C1段及椎動脈V1段同時狹窄,支架置入后出現(xiàn)灌注突破后腦出血,1例基底動脈支架植入后支架發(fā)生穿支事件,1例大腦中動脈支架植入后發(fā)生血管破裂,1例椎動脈V4段支架植入后出現(xiàn)支架內(nèi)急性血栓形成。100例患者術(shù)后隨訪6個月-1年,術(shù)后發(fā)生并發(fā)癥的4例,1例預(yù)后不良,其余3例經(jīng)過臨床處理后基本恢復(fù)正常,殘留輕度神經(jīng)系統(tǒng)癥狀及體征；其余96均未出現(xiàn)再狹窄及與所治療血管相關(guān)的神經(jīng)系統(tǒng)癥狀和體征。結(jié)論本研究顯示,腦血管造影對缺血性腦血管病早期病因的診斷優(yōu)于頭頸部CTA及MRA；經(jīng)過嚴(yán)格的術(shù)前評估,尤其是腦灌注和側(cè)支循環(huán)的評估、術(shù)中選擇合適的材料、術(shù)中術(shù)后規(guī)范用藥、防治并發(fā)癥等方面進(jìn)行系統(tǒng)規(guī)范后,PTAS是治療缺血性腦血管病新的有效治療方法,微創(chuàng)、安全、有效,近期療效肯定,可使過去認(rèn)為難治、不能治的閉塞或重度狹窄的顱內(nèi)外動脈管腔重塑并基本恢復(fù)正常。
[Abstract]:Background and objective ischemic cerebrovascular disease is a common clinical vascular disease, which mainly occurs in the elderly. With the aging of the population in China, the incidence of ischemic cerebrovascular disease is becoming more and more high and has a trend of youth. Atherosclerosis caused by vascular stenosis is an important cause of cerebral ischemic attack and stroke in recent years. As for the treatment of ischemic cerebrovascular disease, great progress has been made in both traditional and new interventional therapy, especially for interventional therapy. People have learned from the experience of coronary artery disease, peripheral vascular disease and hemorrhagic cerebrovascular interventional therapy in a very short time. With the rapid development of neuroimaging, catheter technology, materials, computer and other disciplines, neural interventional technology is becoming more and more mature, and it has become an important treatment for cerebrovascular disease and has gradually developed into an independent subject. Ischemic cerebrovascular disease. Interventional therapy is a clinical medical department that studies the use of intravascular catheter manipulation, with the support of the computer controlled digital subtraction angiography (DSA) system, to diagnose and treat the vascular lesions involved in the human nervous system, and to achieve the purpose of embolization, dissolution, dilation, and forming. The diagnosis and treatment of ischemic cerebrovascular disease can greatly reduce the pain and disability rate of the patients, reduce the family and social burden, get rid of the high incidence of ischemic cerebrovascular disease, the cycle of recurrent disease, and the history of the single drug treatment of ischemic cerebrovascular disease. The interventional therapy of ischemic cerebrovascular disease is nearly twenty. Although the application of this technology in cerebrovascular disease is short and the development is very rapid, the application of intravascular interventional technique in cerebrovascular disease is systematically standardized in the aspects of treatment, screening, postoperative drug use, prevention and treatment of complications. At the same time, intravascular minimally invasive surgery, such as catheter, guide wire, dilated balloon and stent, can make the intracerebral occlusion or severe stenosis of the brain remolded and basically restored to normal in the past. It opens a new way for the treatment of ischemic cerebrovascular disease. It has become a resplendent star in the medical field, which has attracted more and more attention. At present, the interventional operation of ischemic cerebrovascular disease is: transcatheter thrombolysis in acute cerebral infarction, interventional thrombolysis of intracranial venous sinus thrombosis, stent angioplasty for intracranial artery stenosis, and cranial cerebral blood supply artery (common carotid artery, internal carotid artery, and vertebral artery) DSA has become the most important method in the early diagnosis of ischemic cerebrovascular disease, and it is of great value in the preoperative guidance and postoperative evaluation of PTAS; PTAS is a new effective treatment method for the treatment of ischemic cerebrovascular disease with intracranial and intracerebral artery stenosis or occlusion. Safe, effective, recent curative effect. Skilled and standardized operation is the key to the success of stent implantation. Treatment is safe under the strict control of indications and experienced doctors. Current status, 1, carotid atherosclerotic stenosis in the extracranial segment, commonly used therapy, surgical treatment, and intravascular interventional therapy, Among them, the surgical treatment includes carotid endarterectomy (CEA), intracranial and extracranial bypass, and intravascular interventional therapy including angioplasty and stent implantation (carotid artery stenting, CAS), endovascular endovascular resection, mechanically assisted hemangioplasty, and so on. Although surgical treatment of carotid atherosclerotic narrowing is performed. In the narrow method, the operation of endarterectomy is relatively simple, the curative effect has been verified by 50 years of clinical practice, but the CEA in our country has been very limited in the Department of Neurosurgery at all levels for various reasons, and the present several large clinical randomized studies have not shown that CAS is higher than the risk of CEA, so CAS can become carotid atherosclerosis. One of the main methods for the treatment of sexual stenosis; 2, in the atherosclerotic stenosis of the extracranial segment, the standard medical treatment is not clear, and the surgical treatment has a high incidence of complications, and its long-term effect is far less than endarterectomy for carotid stenosis. Although the present stage supports the treatment of extracranial vertebral artery stenosis by angioplasty Evidence based evidence-based medicine is not sufficient, but due to the limitations of drug treatment and surgical operations, intravascular interventional therapy can be considered in patients with ischemic events after medication, and atherosclerotic stenosis of vertebral artery and stent implantation are becoming the focus of research. 3, innominate artery or clavicle. At present, the patients with symptomatic atherosclerotic stenosis or occlusion that are not effective at present, with the development of intravascular interventional therapy and material, the treatment of innominate artery or subclavian artery stenosis or occlusive disease by intravascular interventional therapy has little trauma, quick recovery and satisfactory clinical efficacy. Point, gradually replace arterial bypass grafting and become the preferred treatment. 4, in the treatment of intracranial atherosclerotic stenosis, the present point of view is that for patients with symptomatic intracranial atherosclerotic stenosis, the first should be actively optimized for drug treatment, for patients who are not effective in the drug treatment, such as the clinical condition permitting, and the side. The poor circulation and the degree of stenosis more than 70% can consider intravascular interventional therapy. 5. In the treatment of acute ischemic stroke, the only effective treatment method proved by evidence-based medicine is venous thrombolysis, but venous thrombolysis has short time window, low dissolution rate, high reocclusion rate and a certain bleeding risk, and endovascular thrombolysis, The clinical application of mechanical thrombolytic device and arterial thrombolysis combined with mechanical embolectomy further expands the time window, repassage rate and reducing the risk of bleeding for acute ischemic stroke; 6, the interventional therapy of intracranial venous sinus thrombosis is lacking a strong evidence-based medical evidence that intravascular interventional therapy for patients with intracranial venous sinus thrombosis is lacking. Treatment, but intravascular therapy, including intravascular thrombolysis, mechanical thrombolysis, and intravascular stent implantation, can be considered in patients who have failed to regulate anticoagulant and venous thrombolysis. International guidelines for interventional therapy for ischemic cerebrovascular disease have been greatly updated every year. New techniques, new materials, new treatments and new treatments are available every year. Large clinical research reports, and China has the world's largest group of patients with cerebrovascular disease, but we have not yet carried out large clinical control studies on interventional therapy for ischemic cerebrovascular disease, and lack of evidence based evidence-based medicine for interventional therapy for ischemic cerebrovascular disease in China. However, it should be noted that there may be differences in the characteristics, risk factors and long-term prognosis of cerebrovascular diseases due to different lifestyles, economic and cultural differences, and the differences in the risk factors and long-term prognosis. There may be differences in the location and pathological characteristics of the intracranial and external atherosclerosis. In addition, the socioeconomic status of the patient may also affect the selection of the intervention equipment and the ability to adhere to the medication after the operation. Therefore, these factors should be taken into full consideration when the interventional therapy of cerebrovascular disease is carried out, and the results of the western study are not completely copied. So far, blood vessels The technology of internal intervention has been developed in western countries for many years. It has established a systematic training mechanism for interventional technology, formed a relatively perfect accreditation system for interventional physicians, combined with the supervision and balance of the medical insurance system, and made the intravascular interventional technology into a benign development track. In our country, although neurovascular intervention is involved. The development and clinical application of technology have made great progress, and some areas may still be in the leading position in the world. However, because of the short time, lack of perfect rules and regulations, no systematic personnel training and qualification authentication mechanism, this technology is often the focus of debate inside and outside the industry. It is necessary for different employees to join together to establish a standardized training mechanism for interventional technique for cerebrovascular disease and to establish a feasible accreditation system for interventional physicians to make the neurovascular interventional techniques in our country develop in a reasonable and orderly direction and benefit the majority of patients. This paper discusses the digital subtraction angiography (DSA). The superiority and diagnostic value of the early diagnosis of the etiology of ischemic cerebrovascular disease. At the same time, the selection, technical operation, efficacy and complications of percutaneous transluminal angioplasty and stenting (PTAS) in the treatment of ischemic cerebrovascular disease, and the comparison and analysis of the clinical symptoms of the patients before the operation are compared. Change, the improvement of cerebral blood flow perfusion, preliminarily discuss the safety and effectiveness of PTAS, summarize the curative effect of 100 patients with PTAS and the occurrence and prevention of complications. Method retrospective analysis of the ischemic cerebrovascular disease hospitalized during the treatment of ischemic cerebrovascular disease during the treatment of ischemic cerebrovascular disease from August 2012 to May 2013 in our hospital. In 125 cases, all patients underwent neck color Doppler flow imaging (color Doppler flow imaging, CDFI), transcranial Doppler (transcranial Doppler, TCD), computer tomography (computerized tomography, CT), CT angiography. On, CTP), nuclear magnetic resonance imaging magnetic resonance imaging, MRI), diffusion weighted imaging (diffusion weighted imaging, D WI), nuclear magnetic resonance angiography (magnetic), compared to the diagnostic value of different methods for patients. And the position of the extracranial segment of the vertebral artery and the intracranial vascular stenosis, the degree and preoperative evaluation, according to the indications and contraindications of the interventional therapy of ischemic cerebrovascular disease, 118 vessels of 100 patients were selected for PTAS treatment, and the stent implantation was successfully completed; 119 stents were implanted. The immediate postoperative angiography was evaluated and followed up for 6 months -1 years, DSA Results and clinical analysis of the curative effect and complications of interventional therapy. Results 125 cases of 1250 vascular stenosis were found through DSA examination in 121 cases, and 301 vessels were found in 121 cases, including 73 branches of C1 segment of internal carotid artery, 64 V1 segment of vertebral artery, 38 subclavian artery, 4 innominate artery, 43 branch of middle cerebral artery and basilar artery. 33 branches of V4 segment of vertebral artery, 9 branches of C4 segment of internal carotid artery, 11 branches of C6 segment, 6 branches of C7 segment, 18 vascular occlusion, 142 stenosis between 70% and 99%, 57 branches between 50-69% and 84 branches of stenosis less than 50%. The degree of vascular lesions was found to be the most supported by DSA, and compared with multi-layer spiral CTA and MRA examination. There were 100 patients with severe atherosclerotic severe arterial stenosis, which were all in accordance with the indications of interventional surgery, with a total of 118 vessels and a total of 119 stent implantation. The success rate of 100%. patients was obviously improved after operation; the symptoms were obviously relieved or disappeared, and the nerve function status was observed. Improvement. The anterior blood flow and cerebral perfusion improved obviously. In the perioperative period, 13 TIA patients and 8 patients with obvious dizziness disappeared or improved immediately. 12 cases of intractable hypertension after internal carotid artery stent implantation improved the C1 segment of the internal carotid artery and the V1 segment of the vertebral artery at the same time, and the stent was placed after the stent implantation. After cerebral hemorrhage, there were 1 cases of perforating events after stent placement, and 1 cases of middle cerebral artery stenting.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743

【共引文獻(xiàn)】

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2 何青;唐振剛;任玉奇;王陳維;王郡;陳怡;李正莉;;小膠質(zhì)細(xì)胞活化對癲癇發(fā)病的影響[J];中國組織化學(xué)與細(xì)胞化學(xué)雜志;2013年04期

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10 劉敬禹;宋濤;馬超;劉崎;趙冰輝;陸建平;;3.0 T高分辨率磁共振成像評估動脈粥樣硬化性大腦中動脈狹窄[J];第二軍醫(yī)大學(xué)學(xué)報;2014年10期

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