【摘要】：目的評(píng)價(jià)頸動(dòng)脈支架成形術(shù)(CAS)治療重度頸動(dòng)脈狹窄患者手術(shù)特點(diǎn)、安全性和圍手術(shù)期處理。方法 2011年12月至2016年5月采用CAS術(shù)治療25例頸動(dòng)脈狹窄85%患者,術(shù)中針對(duì)病變狹窄特點(diǎn)應(yīng)用遠(yuǎn)端腦保護(hù)裝置,注重個(gè)體化手術(shù)細(xì)節(jié)和圍術(shù)期處理方案,觀察血運(yùn)重建、腦保護(hù)裝置內(nèi)脫落栓子情況,控制并發(fā)癥發(fā)生。術(shù)后隨訪1年觀察患者缺血性腦血管事件發(fā)生情況。結(jié)果 25例患者腦保護(hù)裝置均通過重度狹窄后成功釋放,球囊預(yù)擴(kuò)張、支架釋放后形態(tài)滿意。北美癥狀性頸動(dòng)脈內(nèi)膜剝脫術(shù)試驗(yàn)研究(NASCET)方法檢測顯示,平均頸動(dòng)脈狹窄程度由術(shù)前(91.0±3.1)%降至術(shù)后(21.0±5.1)%,保護(hù)傘均順利回收,其中6個(gè)傘中發(fā)現(xiàn)脫落組織碎片。圍術(shù)期未出現(xiàn)癥狀性腦出血、腦梗死、氋灌注綜合征、死亡等嚴(yán)重事件。25例患者隨訪1年,無短暫性腦缺血發(fā)作、腦卒中、死亡發(fā)生。結(jié)論 CAS術(shù)治療重度頸動(dòng)脈狹窄患者時(shí)需注意術(shù)中個(gè)體化細(xì)節(jié)管理及圍術(shù)期處理,選擇合適的腦保護(hù)裝置,以確保手術(shù)成功率和安全性。部分重度狹窄患者的術(shù)后療效更直觀而迅速。
[Abstract]:Objective to evaluate the surgical characteristics, safety and perioperative management of (CAS) for severe carotid stenosis. Methods from December 2011 to May 2016, 25 patients with carotid artery stenosis were treated with CAS. According to the characteristics of stenosis, the distal cerebral protective device was used during the operation. The details of individual operation and perioperative management were paid attention to, and the revascularization was observed. The occurrence of complications was controlled by abscission of embolus in cerebral protective device. Patients were followed up for 1 year to observe the occurrence of ischemic cerebrovascular events. Results the protective devices of 25 patients were successfully released after severe stenosis, balloon predilation and satisfactory shape after stent release. The (NASCET) method showed that the mean degree of carotid stenosis decreased from (91.0 鹵3.1)% before operation to (21.0 鹵5.1) after operation, and the protective umbrella was recovered successfully. Among them, shards of tissue were found in 6 umbrellas. There were no symptomatic cerebral hemorrhage, cerebral infarction, perfusion syndrome, death and other serious events in the perioperative period. 25 patients were followed up for one year. There was no transient ischemic attack, stroke and death. Conclusion the individualized detail management and perioperative management should be paid attention to in the treatment of severe carotid artery stenosis by CAS, and appropriate cerebral protective devices should be selected to ensure the success rate and safety of the operation. The postoperative effect of partial severe stenosis is more direct and rapid.
【作者單位】： 解放軍第85醫(yī)院神經(jīng)內(nèi)科;
【分類號(hào)】：R651.1

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本文編號(hào)：2148330