颈动脉内膜切除术治疗症状性颈动脉狭窄40例总结

目的探讨应用颈动脉内膜切除术(CEA)治疗症状性颈动脉狭窄的早期疗效和体会。方法 40例症状性颈动脉狭窄行CEA手术的患者纳入本研究。所有病例均具有脑缺血的临床症状。全组均经颈部彩色多普勒成像、经颅多普勒超声初期筛查检出,9例、3例、28例分别应用增强磁共振血管成像、CT血管造影、数字减影血管造影确诊为颈动脉粥样斑块形成并颈动脉狭窄。40例颅外段颈动脉狭窄程度均≥70%,其中合并溃疡病变5例,一侧颈内动脉狭窄伴另一侧颈内动脉完全闭塞1例。患者全部行全身麻醉联合颈丛神经阻滞麻醉。术中全部放置动脉临时分流管,行颈动脉血管补片成形术32例。结果全组围手术期无死亡病例,脑缺血症状明显改善31例(77.5%),症状好转9例(22.5%)。术后并发高灌注综合征1例,血流动力学不稳定1例。症状性颈动脉狭窄围手术期并发症5.0%(符合美国AHA≤6%的标准)。40例均获随访,在术后6周及3个月复查双侧颈部血管超声,无1例血管再狭窄发生。结论 CEA是治疗症状性颈动脉狭窄安全且有效的方法。     

支架成形术治疗颅内外动脉狭窄的安全性及疗效分析

目的：分析血管内支架成形术治疗颅内外症状性动脉狭窄的效果及安全性。方法：对28例颅内外动脉狭窄患者进行了血管内支架成形术治疗。其中颈内动脉颅外段狭窄10例，大脑中动脉狭窄2例，椎动脉颅外段狭窄9例，椎动脉颅内段狭窄4例，基底动脉狭窄3例。结果：28例患者支架成形术均获成功，术后狭窄率〈15％，28例患者脑缺血症状未再发生，其中1例患者发生偏身感觉障碍，1例术后两周发生脑出血死亡。结论：支架成形术治疗颅内外症状性动脉狭窄是安全有效的，其远期疗效尚待进一步随访、研究。     

颈动脉支架植入术治疗症状性颈动脉狭窄23例疗效观察及影响因素分析

目的:探讨颈动脉支架植入术治疗症状性颈动脉狭窄患者的临床疗效及相关影响因素。方法:将46例症状性颈动脉狭窄行颈动脉支架植入术患者随机分为对照组和观察组各23例,对照组采用传统药物保守治疗,观察组给予颈动脉支架植入术治疗,比较两组终末事件发生率,分析观察组终末事件的影响因素。结果:观察组终末事件发生率低于对照组(P0.05);观察组终末事件影响因素包括年龄、危险因素、高血压、规范抗血小板治疗(P0.05)。结论:颈动脉支架植入术治疗症状性颈动脉狭窄患者效果较好,应重视其影响因素并积极干预。     

彩色多普勒超声在颈动脉支架置入术中的应用价值

目的探讨彩色多普勒超声在支架置人术治疗颅外段颈动脉粥样硬化性狭窄中的作用。方法49例因颅外段颈动脉粥样硬化性狭窄行自膨胀式颈动脉支架置人术的患者,在术前应用彩色多普勒超声测量狭窄处内径、狭窄率,与数字减影血管造影（DSA）比较;在术后1个月和术后12个月测量狭窄处内径、收缩期峰值流速（PSV）、舒张末期流速（EDV）及阻力指数（RI）,并与术前比较。结果彩色多普勒超声测量的狭窄处内径及狭窄率与DSA测值比较差异无统计学意义（P〉0．05）;术后1个月与12个月比较,狭窄处内径、PSV、EDV及RI差异无统计学意义（P〉0．05）,与术前比较狭窄处内径均显著增大（P〈0．05）,PSV、EDV及RT均显著减小（P〈0．05）。1例患者在术后12个月随访时发现支架内再狭窄,经DSA证实后再次行支架治疗。结论彩色多普勒超声对颅外段颈动脉粥样硬化性狭窄的诊断准确性较高,可用于支架置入术前颈动脉狭窄的初选和术后的疗效评价及随访。     

症状性颈动脉狭窄的血管内支架治疗

目的探讨血管内支架置放术治疗症状性颈动脉狭窄的临床效果。方法对35例颈动脉狭窄>70%的患者行血管内自膨式支架置放术,术中选用保护装置27例,行球囊预扩22例,行后扩5例。结果全部患者操作顺利,共置放支架42枚,影像学评价残余狭窄<20%。临床治愈29例,好转6例。随访1～36个月,症状无复发,无再狭窄。结论血管内支架置放术是治疗症状性颈动脉狭窄的一种有效方法,术后再狭窄有待于长期随访。     

老年颅外段颈动脉狭窄的血管内治疗及围手术期护理

目的 探讨老年颅外段颈动脉狭窄患者经皮血管内支架置入血管成形治疗及围手术期护理等相关问题.方法 21例老年颅外段颈动脉狭窄患者经全脑数字减影血管造影(DSA)检查诊断后,均采用经股动脉入路应用自膨式支架行经皮血管内支架置入血管内成形术治疗.结果 21例(次)支架置放均获成功.DSA显示狭窄段的颈动脉直径明显扩大.仅1例出现部分运动性失语.随访2～24个月,全部患者均未再发生脑缺血,其中2例行DSA复查,6例行多普勒超声复查,均无再狭窄发生.结论 经皮血管内支架置入血管成形术治疗老年颅外段颈动脉狭窄安全性高,效果可靠,围手术期护理是手术成功的保障.     

老年颅外段颈动脉狭窄的血管内治疗及围手术期护理

目的探讨老年颅外段颈动脉狭窄患者经皮血管内支架置入血管成形治疗及围手术期护理等相关问题。方法21例老年颅外段颈动脉狭窄患者经全脑数字减影血管造影(DSA)检查诊断后,均采用经股动脉入路应用自膨式支架行经皮血管内支架置入血管内成形术治疗。结果21例(次)支架置放均获成功。DSA显示狭窄段的颈动脉直径明显扩大。仅1例出现部分运动性失语。随访2~24个月,全部患者均未再发生脑缺血,其中2例行DSA复查,6例行多普勒超声复查,均无再狭窄发生。结论经皮血管内支架置入血管成形术治疗老年颅外段颈动脉狭窄安全性高,效果可靠,围手术期护理是手术成功的保障。     

TCD和CTA对颈内动脉支架植入前后的评估价值

目的探讨经颅多普勒超声（TCD）和CT血管造影术（CTA）对颈内动脉颅外段狭窄的筛查价值和颈动脉支架植入术（CAS）后随访中的价值。方法对行TCD与CTA筛查、并经数字减影血管造影（DSA）证实的108例颈内动脉颅外段狭窄病人行CAS。术后6个月病人均行TCD检查,24例病人行CTA与DSA检查,55例病人行CTA检查,29例病人行DSA检查。将TCD、CTA结果与DSA结果相比较。结果以DSA结果为金标准,TCD和CTA与之比较,术前诊断颈内动脉颅外段狭窄一致性极好。支架植入后应用TCD与CTA随访,二者与DSA随访结果的符合率达100%。结论 TCD与CTA对颈内动脉颅外段狭窄的诊断可靠性好,二者联合应用可在支架治疗前后的评估中替代DSA。     

颈动脉支架成形术治疗症状性颈动脉狭窄的效果观察

目的:观察颈动脉支架成形术治疗症状性颈动脉狭窄的疗效。方法 :收集2013年1月~2014年3月我院治疗的症状性颈动脉狭窄患者119例,其中观察组60例,给予颈动脉支架成形术治疗,对照组59例,采用内科保守治疗,比较两组患者的治疗效果,记录手术并发症,术后一年随访比较复发情况。结果:观察组共置入63枚支架,手术成功率达100%。治疗后观察组病变狭窄率明显低于对照组(P0.05);分别于治疗后3、6、12个月对两组患者行NIHSS评分随访,观察组评分明显均低于对照组(P0.05)。治疗后12个月随访,观察组复发率5.00%,病死率5.00%;对照组复发率达22.03%,病死率为18.64%,两组比较均有显著差异(P0.05)。结论:应用颈动脉狭窄支架成形术治疗症状性颈动脉狭窄安全有效,复发少,并发症少,值得临床推广。     

支架置入术治疗颅外动脉狭窄的疗效及并发症探讨(附12例报告)

目的 观察支架置入(SP)术治疗颅外动脉狭窄的疗效及其并发症.探讨对各种并发症的处理方法.方法 为12例因颅外动脉(颈内动脉颅外段、椎动脉)狭窄患者(平均年龄63.9)行SP术治疗.术前术后行脑血管造影.术中术后给予抗凝治疗.结果 12例均成功放置支架,3例出现高灌注综合征,1例死亡,2例经对症治疗后痊愈;6例颈内动脉支架均使用脑保护装置,3例术后保护装置内有脱落物,1例术后出现假性动脉瘤.结论 支架置入术治疗脑血管狭窄有效、彻底,但并发症较多,要严格规范操作,正确应对.     

支架置入及经皮血管成形治疗颅外颈动脉狭窄

背景：颈动脉支架置入是一种微创、安全、简便的介入治疗方法,对于身体基础状况差不能耐受开放手术的颈动脉狭窄患者尤其有意义。 目的：探讨支架置入联合经皮血管成形治疗颅外颈动脉狭窄的临床效果。 方法：纳入颅外颈动脉狭窄患者29例,其中男19例,女10例,年龄45-78岁,进行支架置入及经皮血管成形治疗,治疗前及治疗后24 h进行美国国立卫生研究院卒中量表量表、神经功能评分及CT检查;随访3-12个月,复查凝血指标及颈动脉B超。 结果与结论：1例患者为右侧颈总动脉分叉部完全闭塞,经治疗仅颈外动脉管径恢复50.0%,其余患者均经血管造影证实完全恢复至正常水平,治疗成功率为97%。29例患者治疗后24 h的颈动脉病变血管长度、美国国立卫生研究院卒中量表量表、神经功能评分均较治疗前明显改善（P＜0.01,P＜0.05）。随访3-12个月,所有患者均未出现脑梗死和短暂脑缺血发作,颈动脉狭窄明显改善,6个月复查时患者出现再狭窄,再狭窄率为3%。表明经皮血管成形联合生物材料支架置入治疗颅外颈动脉狭窄可以获得良好的临床效果。     

Randomized clinical trials: impact on clinical practice for symptomatic and asymptomatic extracranial carotid occlusive disease

Carotid artery stenting (CAS) has emerged as a useful and potentially less invasive alternative to carotid endarterectomy (CEA) for the treatment of extracranial carotid stenoses. In this regard, it has been suggested that specific patient subgroups who may benefit from CAS including those with significant medical comorbidities, recurrent stenosis, anatomically inaccessible lesions, and a hostile neck. However, the purpose of this report is to evaluate whether or not CAS should replace CEA in the treatment of symptomatic and asymptomatic disease in better risk patients, also. This report contains results from recently published randomized clinical trials.     

支架植入与内膜剥脱治疗颈动脉狭窄的疗效与安全性评价

背景：大型随机试验已证明颈动脉内膜剥脱或支架植入治疗有症状和无症状颅外颈动脉狭窄是有效的。目的：用Meta分析方法评价颈动脉支架植入和颈动脉内膜剥脱治疗颈动脉狭窄的疗效及安全性。方法：计算机检索国内外数据库中关于颈动脉支架植入和颈动脉内膜剥脱治疗颈动脉狭窄的相关随机对照试验,按照纳入排除标准进行文献筛选和质量评价后,采用Cochrane协作网提供RevMan 5.0软件进行Meta分析。结果与结论：共纳入14个研究7 693例患者,其中支架植入组3 835例,颈动脉内膜剥脱组3 858例。支架植入组术后30 d脑卒中事件发生率、术后30 d死亡与脑卒中事件发生率、术后1年心肌梗死事件发生率及术后30 d非致残性脑卒中事件发生率高于颈动脉内膜剥脱组（P≤0.000 1）,术后30 d心肌梗死事件发生率低于颈动脉内膜剥脱组（P=0.001 0）。两组术后30 d死亡事件发生率及致残性脑卒中事件发生率差异无显著性意义。两种治疗模式是互补而不是对立的,应该综合分析每例患者的病情,对治疗方案进行优化选择。     

CT灌注成像在颅内外动脉狭窄支架置入术随访中的初步临床应用

目的：利用CT灌注成像评价颅内外动脉狭窄血管支架置入术前后的脑血流动力学改变。方法：颅内外血管支架置入术前后做CT灌注成像检查的病人9例，比较手术前后MTT图、CBF图及CBV图的变化。结果：9例病人中3例为单支动脉狭窄，1例术前存在供血区缺血改变，术后复查CT灌注图像缺血区无明显改善，另2例术前术后未见脑缺血改变。6例为多支动脉狭窄，其中4例存在一侧颈内动脉狭窄而另一侧颈内动脉闭塞，术前CT灌注图像示1例双侧缺血；3例闭塞侧缺血，狭窄侧无缺血。术后复查双侧缺血病例术侧缺血有轻度改善，而对侧血管闭塞侧缺血加重；3例闭塞侧缺血的病例2例闭塞侧缺血加重，1例术前后无变化。术后病人均无合并症发生。结论：CT灌注成像能在血管支架置入术后早期即可显示出脑血流动力学的变化，是一种简单方便了解手术对脑循环影响的影像学方法。     

Duplex sonographic predictors of restenosis,vascular and neurological events after carotid endarterectomy

BACKGROUND: Although excellent short- and long-term results have been achieved with surgery in extracranial internal carotid artery stenosis, recurrent stenosis continues to play an important role in post-endarterectomy. Therefore, a close follow-up of patients is warranted. The value of postoperative duplex sonographic evaluations in postoperative follow-up is highly disputed. The study evaluates duplex sonographic parameters as predictors of carotid restenosis, general vascular events and ipsilateral neurological symptoms, in order to assess the role of duplex sonography in follow-up after carotid endarterectomy. METHODS: A retrospective cohort study with a follow-up period ranging from 7 months to 7.5 years was performed in 150 patients who underwent carotid endarterectomy. Pre- and postoperative duplex sonographic and clinical data were analyzed by life-table analysis and multivariate Cox regression with respect to carotid restenosis, vascular and ipsilateral neurological events. MAIN FINDINGS: Duplex sonographic predictors of carotid restenosis include the postoperative degree of stenosis (residual stenosis > or = 30% or more: relative risk (RR) = 1.56; 1.05-2.32), pre- to postoperative reduction of stenosis (higher than 50%: RR = 0.61; 0.45-0.83), and residual plaques in the operated carotid artery (RR = 1.96; 1.31-2.93). Some of these morphological parameters such as reduction of stenosis are also predictive of vascular events (RR = 1.25; 1.01-1.56) and ipsilateral neurological events (RR = 1.52; 1.05-2.19). In 12 cases restenosis was discovered by duplex sonography and in 3 cases by evaluation of clinical symptoms. In 5 cases restenosis was treated by repeat surgery. Contralaterally, progressive or newly developed carotid stenoses were observed in 17 cases, and only 5 were discovered on the basis of clinical symptoms. Fourteen contralateral stenoses required surgery. Overall, 12 patients underwent treatment for stroke prevention on the basis of duplex follow-up findings (8% of the study population). CONCLUSIONS: Postoperative duplex sonography allows for the identification of patients at risk for carotid restenosis as well as those at risk for other vascular events. As expected, regular examinations permit early detection of restenosis requiring surgical treatment. However, a large number of contralateral stenoses requiring surgical treatment were detected by routine duplex sonographic examinations. The timing of follow-up intervals may be oriented towards the perioperative outcome of duplex sonography.     

Cerebral blood flow measurement by color velocity imaging in radiation-induced carotid stenosis.

OBJECTIVE: To show whether there is any association between the development of neurologic symptoms and the total cerebral blood flow volume documented by color velocity imaging in patients with carotid stenosis that develops after radiotherapy. METHODS: Twenty-three patients with nasopharyngeal carcinoma (4 female and 19 male; age range, 39-69 years; mean age, 55.6 years) and major extracranial carotid stenosis underwent color velocity imaging. In this group, 8 patients had symptoms of a stroke or transient ischemic attack, and the other 15 patients were asymptomatic. The color velocity imaging results in the symptomatic group were then compared with those in the asymptomatic group. RESULTS: The cerebral blood flow in the symptomatic group was significantly lower than that in the asymptomatic group (224.1 +/- 89.0 versus 532.5 +/- 89.0 mL/min; P = .001). CONCLUSIONS: Cerebral blood flow as measured by color velocity imaging was lower in the symptomatic group. There is an association between the development of neurologic symptoms and blood flow volume.     

Carotid artery stenting versus carotid endarterectomy in the treatment of symptomatic and asymptomatic carotid stenosis: a systematic review and meta-analysis

Purpose: To evaluate the short-term and intermediate- to long-term efficacy and safety of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA).Materials and Methods: The published literature was electronically searched for randomized controlled trials (RCTs) between CAS and CEA for the treatment of carotid stenosis performed from January 2000 to January 2017. The short-term and intermediate- to long-term outcomes were evaluated.Results: We identified 10 RCTs including 7,183 participants with symptomatic or asymptomatic carotid stenosis. Our meta-analysis found different results between the patients with and those without symptoms. In patients with symptomatic carotid stenosis, the total stroke incidence in the CAS group was significantly higher than that in the CEA group within the 30-day periprocedural period (p<0.001); however, the myocardial infarction incidence in the CAS group was significantly lower than that in the CEA group (p<0.05). There was no significant difference between the two groups in the mortality within 30 days post-procedure, but the intermediate- to long-term incidence of stroke or death in the CAS group was higher than that of the CEA group (p<0.05). In contrast, for asymptomatic patients, there were no significant differences between the CAS and CEA groups in the short- and intermediate- to long-term outcomes.Conclusion: For patients with symptomatic carotid stenosis, CEA is associated with an increased risk of myocardial infarction, whereas CAS is correlated with an increased risk of procedurally related strokes. However, for patients with asymptomatic carotid stenosis, no significant difference was found in the efficacy or safety between CAS and CEA.     

Superficial temporal artery to middle cerebral artery bypass and external carotid reconstruction for carotid restenosis after angioplasty and stent placement

The recent proliferation of endovascular treatment of carotid atherosclerotic disease will increase the number of patients who require treatment for recurrent carotid stenosis after angioplasty and stent placement. The optimal management of these patients has not yet been defined. We describe a 66-year-old woman who required 2 surgical procedures for recurrent in-stent carotid stenosis. She experienced numerous transient ischemic attacks 5 months after left extracranial internal carotid artery angioplasty and stenting for asymptomatic stenosis. Angiography showed high-grade in-stent restenosis, left intracranial carotid artery stenosis, and poor collateral flow to the left middle cerebral artery circulation. The patient underwent a superficial temporal artery to middle cerebral artery bypass, and the transient ischemic attacks resolved. Five months later, angiography showed progressive stenosis of the external carotid artery at the site of the stent. The patient underwent successful external carotid reconstruction with an on-lay patch. Extracranial-intracranial bypass grafting may be used successfully in the treatment of recurrent extracranial carotid artery stenosis after angioplasty and stent placement. Also, external carotid artery reconstruction at the site of an internal carotid artery stent can be performed safely.