腔内支架成形术治疗症状性颅内动脉狭窄

目的研究腔内支架成形术治疗症状性颅内动脉狭窄的安全性及有效性。方法对7例症状性颅内动脉狭窄的患者行腔内支架成形术治疗。结果7例患者中6例成功置入8枚冠脉支架,1例因支架置入困难仅行经皮腔内血管成形术(PTA),6例患者术后均未发生脑缺血发作,2例患者术后3～8个月复查经颅多普勒超声(TCD)血流通畅,未见内膜过度增生,1例单纯PTA患者术后症状明显改善,1例基底动脉支架成形术后出现动眼神经麻痹。结论腔内支架成形术是治疗症状性颅内动脉狭窄的安全、有效的方法,其长期疗效还需进一步随防研究。     

腔内支架成形术治疗症状性颅内动脉狭窄

目的 研究腔内支架成形术治疗症状性颅内动脉狭窄的安全性及有效性.方法 对25例症状性颅内动脉狭窄的患者行腔内支架成形术治疗.结果 25例患者中24例成功置入26枚冠脉支架,1例因支架置入困难仅行PTA术.22例患者术后均未发生脑缺血发作,1例单纯PTA患者术后症状明显改善,1例患者术后9个月复查TCD可见内膜增生,1例基底动脉支架成形术后出现动眼神经麻痹,1例出现再灌注损伤.结论 腔内支架成形术是治疗症状性颅内动脉狭窄的安全、有效的方法,其长期疗效还需进一步随防研究.     

血管内支架成形术治疗症状性颅内动脉狭窄

目的：探讨血管内支架成形术治疗颅内动脉狭窄的可行性及疗效。材料和方法：对27例症状性颅内动脉狭窄行血管内支架成形术,其中颈内动脉颅内段狭窄8例、大脑中动脉狭窄11例、基底动脉狭窄1例和椎动脉颅内段狭窄7处。结果：27例中,支架成形术成功26例(96．3%),狭窄程度从术前76．3±10．1%降至术后8．2±6．9%。其中1例因颈内动脉虹吸段过度迂曲导致支架植入失败,2例术后24h内发生颅内出血,1例术后发生支架内血栓再形成,无手术死亡。22例随访0．5～1a(平均7．5个月),无缺血性脑卒中发生。结论：血管内支架成形术是治疗颅内动脉狭窄的有效方法,具有较高的成功率及一定的安全性,但长期疗效有待于进一步随访。     

经皮血管内球囊扩张及支架置入术治疗症状性大脑中动脉狭窄

目的：探讨症状性大脑中动脉狭窄的血管内治疗适应证、技术可行性及疗效。方法：回顾性分析自1997年3月至2001年10月收治的经血管内方法治疗的症状性大脑中动脉狭窄14例患者的技术成功率、并发症以及临床疗效，14例患者中9你是2001年以前的病例，单纯采用血管内球囊扩张术，而2001年5例患者全部采取血管内支架成形术。结果：采用球囊扩张的9例患者成功扩张5例，从术前平均狭窄67％扩张到术后的18％，2例由于球囊到位困难而放弃，2例患者出现与技术有关的严重并发症。该5例手术成功的患者，经过平均21个月随访，症状消失2例，所有患者随访期间病情平稳，无卒中发生。5例近期使用冠状动脉支架置入患者，4例成功，术后即刻造影显示狭窄程度从术前的平均85％下降到术后的平均10％，大脑中动脉血流明显增加。1例在支架到位后出现血管破裂。短期随访无卒中再发作（3-5个月）。结论：经皮球囊血管成形术以及支架置入术对于症状性大脑中动脉狭窄的治疗有效，技术可行。支架血管内成形术虽然刚刚起步，更有发展潜力，需要进一步的实践和临床随访。     

经皮血管内支架成形术治疗症状性椎基底动脉狭窄

目的探讨经血管内支架成形术治疗症状性椎基底动脉狭窄的适应证、疗效及安全性。方法应用经皮血管内支架成形术对13例经内科药物治疗无效的症状性椎基底动脉狭窄进行治疗。结果13例患者术前狭窄为(76.15±15.11)%,术后狭窄为(3.69±3.04)%。围手术期无并发症,术后无缺血性脑卒中发作,随访8~12个月,10例症状完全消失,2例症状较术前明显好转,偶尔有头晕,1例症状改善(DSA显示多段狭窄,左侧大脑后动脉闭塞,小脑后下动脉显影差)。结论症状性椎基底动脉狭窄患者,内科治疗无效时,经皮血管内支架成形术是一种安全有效的微创治疗手段,可以缓解椎基底动脉狭窄患者的脑缺血症状,预防脑卒中的发生。     

血管内支架成形术治疗症状性大脑中动脉狭窄

目的　总结血管内支架成形术治疗症状性大脑中动脉狭窄的疗效和初步经验。方法　对2 0例药物治疗无效的、反复短暂性缺血发作 (TIA)或有明显脑缺血症状的大脑中动脉狭窄患者行血管内支架成形术。术后常规给予抗血小板治疗 ,血管造影及TCD、SPECT进行影像学随访。结果　狭窄的血管均成功地进行扩张 ,术前术后狭窄程度分别为 (78.3± 4 .7) %与 (15 .6± 4 .4 ) % ,术后残余狭窄程度均小于 3 0 %。临床随访无TIA或脑梗死再发 ,DSA随访无血管再狭窄发生 ,经颅多普勒超声 (TCD)、SPECT检查显示脑血流明显改善。 1例发生大脑中动脉破裂出血。结论　血管内支架成形术治疗大脑中动脉狭窄是安全、有效的 ;长期疗效有待于进一步观察     

经皮血管内治疗症状性颅内脑动脉狭窄

目的　研究对症状性颅内脑动脉狭窄进行血管内治疗的可行性和安全性。方法　 19例症状性颅内脑动脉狭窄患者接受了内支架成形术或球囊成形术治疗。结果　本组MoriA型病变 12例 ,B组病变 5例 ,C型病变 2例 ;狭窄位于大脑中动脉 11例、大脑前动脉 1例、颅内颈内动脉 1例、颅内椎基底动脉 6例。在球囊成形术 (3例 )和内支架成形术 (16例 )后 ,平均动脉狭窄率从 82 .9%下降到8.0 % (P <0 .0 1)。在围手术期内 ,除 1例 (左大脑中动脉MoriC型病变 )发生蛛网膜下腔出血、死亡外 ,余无严重并发症发生。存活的 18例平均随访 3.7个月 (1～ 9个月 ) ,未发生缺血性神经事件。结论　内支架成形术或球囊成形术是治疗症状性颅内脑动脉狭窄有效的方法 ,但安全性尚需进一步研究 ,C型病变应当视为禁忌证。     

应用血管内支架治疗头臂动脉狭窄或闭塞性疾患

目的　探讨应用血管内支架治疗头臂动脉狭窄或闭塞性疾患。方法　 8例头臂动脉阻塞性疾病患者接受血管内支架成形术治疗 ,分别选用自展式Wallstent及热变形记忆合金式Angiomed、Symphony血管内支架。结果　 7例成功施行血管内支架成形术 ,其中颈总动脉 4例 ,锁骨下动脉 3例 ,共置入血管内支架 7枚。术后临床症状得到明显改善或消失。 1例锁骨下动脉闭塞的患者未成功。在 1～ 2 4个月的随访中 ,1例颈总动脉血管内支架术后 9个月闭塞。结论　经皮血管内支架成形术可有效解除头臂动脉阻塞所致的血液循环障碍 ,因其技术简便 ,可成为治疗头臂动脉狭窄或闭塞性疾患的主要治疗手段。     

Wingspan自膨式支架在症状性大脑中动脉狭窄中的应用

目的 探讨Wingspan支架成形术治疗症状性大脑中动脉水平段(M1段)狭窄的安全性和可行性.方法 回顾性分析32例经自膨式支架治疗的症状性大脑中动脉缺血反复发作、药物治疗无效的大脑中动脉狭窄患者的临床资料.本组男19例、女13例,平均年龄(49±19)岁.所有患者经过Gateway球囊预扩后,植入Wingspan自膨式支架.术后6个月对所有患者均进行电话或门诊随访,并建议所有随访患者进行经颅超声多普勒检查或血管造影检查,分析本组患者手术成功率、并发症以及临床疗效.结果 32例患者均成功植入支架,术前M1段狭窄率平均(76.5±15.4)%,支架植入后平均(19.3±9.2)%;球囊预扩引起1例颅内出血、1例M1段急性闭塞,无一例死亡.术后6个月随访无一例患者再发生缺血性神经事件;19例患者在术后6个月行经颅超声多普勒检查,结果显示血流速度正常;5例行血管造影.均显示支架段开通良好,8例患者拒绝影像检查.结论 采用自膨式支架对有症状的M1段狭窄进行成形术可行、安全,近期随访证实疗效确切,但长期疗效还需要进一步观察.     

血管内支架成形术治疗颅内动脉狭窄28例

目的探讨血管内支架成形术治疗颅内动脉狭窄的临床效果和安全性。方法 2006年7月—2010年12月,采用经皮血管内支架成形术治疗颅内狭窄28例。结果治疗狭窄颅内动脉28支,其中置入冠脉球扩式支架16枚,Wingspan支架6枚,apollo支架6枚,支架不能到位,放弃手术1例。27支动脉狭窄程度均明显改善,狭窄程度由原来的(89.36±5.63)%下降至(4.23±1.57)%,无死亡病倒,术后27例患者症状均明显改善,1例基底动脉重度狭窄患者术后出现一侧肢体麻木的并发症,1例术后出现脑栓塞表现,3 d后恢复正常,其他26例患者无并发症,随访2～12个月,无短暂性脑缺血发作(TIA)发作,随访患者经颅多普勒超声(TCD)结果显示,原狭窄血管近端、远端血流速度和支架置入后24 h的TCD结果无明显差别。结论血管内支架成形术是治疗症状性颅内动脉狭窄的安全、有效的方法,临床效果好,并发症少。适应证的正确选择、术中熟练的导管导丝技术和围术期的专业处理是手术成功的关键,但其远期疗效还需要长期随访。     

Elective stenting of symptomatic middle cerebral artery stenosis

Percutaneous balloon angioplasty has been found to be useful for the treatment of intracranial atherosclerotic arterial stenosis. Nonetheless, an ongoing risk of this procedure is arterial dissection, which increases the hazards of acute closure, stroke, and restenosis. Stenting of the intracranial vasculature recently has been shown to be feasible in a variety of circumstances. To our knowledge, however, stenting of the middle cerebral artery has not been possible until now primarily because of difficulty with tracking stents across the carotid siphon. We describe the successful treatment of a symptomatic middle cerebral artery stenosis achieved using a balloon-expandable flexible coronary stent.     

腔内支架成形术治疗症状性椎动脉狭窄

目的　研究腔内支架成形术治疗症状性椎动脉狭窄的安全性及有效性。方法　对 11例症状性椎动脉狭窄的患者行腔内支架成形术治疗。 11例患者成功地植入 12枚球囊扩张支架 ,无一例发生严重并发症。结果　术后见狭窄程度明显改善 ,<2 0 %。在 6个月的临床随访中 ,11例患者均无脑缺血发作及再狭窄发生。TCD示血流通畅 ,未见内膜过度增生。结论　腔内支架成形术是治疗症状性椎动脉狭窄的安全、有效的方法 ,其长期的效果还需进一步随访研究     

Solitarie支架在颅内动脉硬化性狭窄治疗中的应用

目的探求Solitaire自膨支架对颅内动脉狭窄疗效的可行性。 方法回顾总结5例颅内动脉狭窄患者,实施球囊扩张Solitaire支架成形术,共留置支架6枚。病变部位位于大脑中动脉M1段3例,基底动脉段1例,颈内动脉前床突段1例;病变长度为(8±2.9)mm,狭窄率为(73±8.5)%。 结果手术成功率100%,术后残余狭窄率为(14±4.2)%。DSA随访平均时间10.5个月,无支架内再狭窄发生;1例患者术后出现患侧TIA发作两次。 结论使用Solitaire自膨支架可以对颅内重度狭窄病变行支架成形术具有一定可行性,但需更进一步研究。     

应用支架成形术处理颈动脉系血管狭窄

应用血管内支架成形技术治疗颈动脉系血管狭窄14例，狭窄位于颈动脉分叉部6例，颈内动脉颅内段3例，大脑中动脉水平段3例，颈总动脉起始部2例。均经股动脉入路，依据动脉狭窄的程度和长度，13例分别选用不同型号的Smart自膨式支架和Biodivysio管状支架进行血管内成形，1例行球囊扩张成形。14例均获成功，神经功能有不同程度的改善，术后卒中量表（NIHSS）测定无卒中发生；随访3－14个月，无TIA等缺血性神经损害发生。本组初步结果表明，应用支架成形技术经血管内治疗颈动脉系血管狭窄操作较安全简便，效果良好。     

Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis

BACKGROUND AND PURPOSE: Percutaneous transluminal angioplasty (PTA) for significant stenosis involving the origin of the vertebral artery is now a well established treatment for selected patients when posterior cerebral arterial circulation is compromised. Arterial spasm, dissection, and restenosis may occur in some instances, with subsequent hemodynamic compromise. To prevent these potential complications, we combined PTA of the vertebral artery with primary stenting, using coronary stents, in seven patients. We herein present our short- and intermediate-term results. METHODS: A total of seven lesions affecting the origin of the vertebral artery were treated by primary trans-stenotic coronary stent placement. All patients were symptomatic, fulfilling the general criteria for vertebral artery angioplasty. Patients were followed for up to 36 months after treatment. RESULTS: All seven lesions were successfully dilated. Residual stenosis was never greater than 20% in diameter. No perioperative complications occurred. Clinical follow-up showed immediate resolution or improvement of symptoms in all patients. One patient's condition deteriorated 15 months after stent placement because of atheromatous stenosis of the prevertebral segment in the ipsilateral subclavian artery. CONCLUSION: Stent placement to treat significant stenosis involving the origin of the vertebral artery is safe and effective for alleviating symptoms and improving blood flow to the posterior cerebral circulation. Coronary stent design seems to be particularly well suited to cover atherosclerotic lesions of the origin of the vertebral artery. The stent mesh probably prevents elastic recoil and early restenosis after PTA, as it does in coronary arteries.     

Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease

BACKGROUND AND PURPOSE: The safe performance of percutaneous transluminal cerebral angioplasty for intracranial atherosclerotic lesions requires that the risk of complications, such as acute occlusion or symptomatic dissection, and restenosis be reduced. Our purpose was to assess the effectiveness, safety, and short-term arteriographic and clinical outcome of cerebral angioplasty and stenting (CAS) for intracranial vertebrobasilar and distal internal carotid atherosclerotic occlusive lesions. METHODS: Between March 1998 and November 1998, 10 patients with 12 intracranial atherosclerotic lesions of the vertebrobasilar artery and the distal internal carotid artery underwent treatment with flexible balloon-expandable coronary stents. RESULTS: Although in two of the 10 patients CAS was not successful because of the inability to access the site of arterial stenosis, 10 lesions in eight patients were successfully dilated with stents. No complications occurred during or after the procedure and no neurologic ischemic events or restenoses occurred during the follow-up period. CONCLUSION: CAS appears to be a safe and effective means for treating intracranial atherosclerotic occlusive disease, yielding a favorable arteriographic and clinical outcome.     

Adjuvant use of abciximab for balloon angioplasty of symptomatic middle cerebral artery stenosis

PURPOSE: To evaluate the safety of adjuvant intravenous use of abciximab in balloon angioplasty for symptomatic middle cerebral artery stenosis. MATERIAL AND METHODS: Seven patients with symptomatic stenosis at the main trunk (n=5), or proximal post-trifurcation portion (n=2) of the middle cerebral artery, were enrolled in the study. A bolus dose of abciximab (0.15 mg/kg) was given intravenously immediately before the procedure. The immediate morphologic results as well as the presence of hyperacute thrombosis or hemorrhage after angioplasty were evaluated. Clinical evaluation was performed 1 day and 1 month following angioplasty. Oral antiplatelets were administered during the follow-up period. Follow-up angiography was performed after 7 to 14 (mean 10.4) months. Stenosis of a vessel greater than 50% was considered as restenosis. RESULTS: The procedure was technically successful in all patients. Immediate residual stenosis was insignificant in 4 and mild (less than 50%) in 3 patients. There was no evidence of intimal dissection. Mild gum bleeding was noted in two patients. All study patients were clinically stable at follow-up without newly developed neurological abnormality even though there was one case of occlusion and one case of restenosis on follow-up angiography. Angiographic patency rate was 71%. CONCLUSION: In performing proximal middle cerebral artery balloon angioplasty, abciximab may be safely used to prevent acute thrombosis. The mid-term patency of the vessels was also acceptable.     

颅内外缺血性多血管病变的介入治疗选择

目的：通过选择性介入治疗颅内外缺血性多血管狭窄性病变,评价多血管病变介入治疗的安全性。方法：对150例颅内外缺血性多血管病变介入治疗的相关资料进行系统性回顾。结果：1150例多血管病变者,双侧颈内动脉同时狭窄〉70%者47例;单侧颈内动脉狭窄并单（或双）椎动脉狭窄〉70%者61例;双侧椎动脉狭窄〉70%者23例;单侧血管颅内外串联病变均需处理者19例。2共成功植入支架218枚,围手术期并发症5例（3.33%）,126例患者术后6-12个月随访无短暂性脑缺血发作及新发脑梗死。结论：通过对颅内外缺血性多血管狭窄性病变的介入治疗选择,可减少围手术期及远期并发症。