血管内支架植入术治疗缺血性脑血管病的临床报告

　　摘要 :目的 探讨血管内支架植入术治疗缺血性脑血管病的疗效、安全性及并发症。 方法 5例脑供血动脉狭窄分别为:颈动脉起始部狭窄1例、优势椎动脉开口部狭窄1例、优势椎动脉颅内段狭窄3例。行血管内支架植入术治疗。 结果 1例颅内段椎动脉狭窄的病例由于手术径路差，支架无法到位而中止手术，其余4例均获得技术上的成功，残余狭窄率小于10%。术中颈内动脉支架植入术患者出现一过性心率减慢，经使用阿托品后恢复正常，术后该患者48h内出现血压下降，经使用多巴胺后血压逐渐恢复正常。1例椎动脉支架患者术后穿刺点部位出现假性动脉瘤，经局部压迫而治愈。所有患者均无手术相关的严重并发症出现。手术成功病例术后随访3个月无症状复发。 结论 对存在严重血管狭窄的缺血性脑卒中患者血管内支架植入术可能是有效的、安全性高的治疗方法。

　【关键词】 脑;动脉;,狭窄;,支架;,血管成形术

　　The application of endovascular stent-assisted angioplasty in patients with

　　ischemic cerebral angiopathy

　　TAO Zhong-hai，RONG Liang-qun，WEI Xiu-e，et al

　　(Department of Neurology，The Second Affiliated Hospital of Xuzhou Medical College，Xuzhou，Jiangsu221006，China)

　　Abstract:Objective To study the efficacy，safety and complicated symptoms of endovascular stenting in the treatment of ischemic cerebral angiopathy.Methods Endovascular stenting was performed in5patients:one with stenosis at the beginning of left internal carotid，one with stenosis at the beginning of the dominant vertebral artery，and three with the stenosis in the in-tracranial segment of the dominant vertebral artery.Results The stent failed to reach the intracranial vertebral artery stenosis in1case，because of the tortuous path of the artery.Stenting was successful in the other4cases.Postoperative bradycardia and sequential hypotension in the case of internal carotid was corrected with drugs.False aneurysm at the site of puncture in one case of vertebral artery stenosis was cured by applying pressure dressing.No other serious complications occurred.Follow-up for3months showed smooth postoperative courses.Conclusion Endovascular stenting may be a safe and preferable choice of treat-ment for severe cerebral arterial stenosis.

　　Key words:brain;artery;stenosis;stent;angioplasty

　　缺血性脑血管病具有复发率高、致残率高、死亡率高的特点。目前对于存在脑供血动脉狭窄的缺血性脑血管病主要治疗措施仍然是采用药物干预，然而每年有10%～24%的患者再次发生脑卒中[1] 。血管内支架植入术目前被认为是处理脑供血动脉狭窄有效的治疗手段。我院2005年4月―2005年11月期间共对5例脑供血动脉狭窄的患者行血管内支架植入术，现报道如下。

[1] [2] [3] [4] 下一页