颈动脉颅外段与颅内动脉狭窄血管内成型术疗效对比分析

目的:探讨颈动脉颅外段与颅内动脉狭窄血管内成型术疗效.方法:选取2009年1月～2011年1月收入的患者共36例,其中颅内血管狭窄患者15例,颅外血管狭窄患者21例,给予手术治疗,患者术后随访3年,行数字减影血管造影(TCD)及经颅多普勒超声(DSA)评价、ASPECTS量表评分,并对患者术后并发症进行评估.结果:本组36例患者全部放置成功,患者术后各项参考均显著改善,轻度狭窄的TCD与DSA相符率为56%,中度与重度的相符率分别为75%与78%.患者术后1月、1年、3年的峰值流速、舒张末期流速、平均流速较术前减慢,而脉动指数较术前增高,差异均有统计学意义(P＜0.05).两组患者术后1月及术后3年的ASPECTS评分与术前对比差异有统计学意义(P＜0.05).两组患者行支架治疗后,颅内支架组患者成功14例,失败1例,成功率93.3%.术后脑出血2例,血管痉挛1例,再闭塞2例,心率、血压下降1例.颅外支架组成功20例,失败1例,成功率95.2%.再闭塞1例,心率、血压下降5例.结论:血管内支架成形术可以很好的治疗症状性脑动脉狭窄,但技术要求较高,尤其是颅内血管支架成形术.和颅外血管支架成形术相比,颅内血管支架成形术术后并发症相对较多.

Comparative Efficacy Analysis of Extracranial and Intracranial Arterial Stenosis in the Carotid Angioplasty

Objective:To investigate the carotid artery of extracranial and intracranial artery stenosis angioplasty efficacy.Methods:36 cases Patients were selected from January 2009 to January 2011,15 cases were intracranial vascular stenosis,21 cases were extracranial artery stenosis,they were all given the surgery,patients were followed up for 3 years,by TCD,and DSA in evaluationASPECTS scale score,and postoperative complications were evaluated.Results:All 36 patients were placed successfully,The parameters of the patients after surgery were significantly improved,consistent with mild stenosis TCD and DSA rate of 56%,moderate and severe match rate of 75% and 78%,respectively.Patients in January,1 year,3-year peak flow velocity,diastolic velocity,mean flow velocity compared with the preoperative slow down,and pulsatility index is higher than before surgery,the differences were statistically significant(P<0.05).There was significant difference in ASPECTS score between preoperative and 1 month or 3 years after surgery(P<0.05).The two groups of patients with stents in patients with intracranial stent group successful in 14 cases,failure of one cases,the success rate of 93.3%.2 cases of postoperative intracerebral hemorrhage,vasospasm,and 2 cases of re-occlusion,heart rate,blood pressure decreased by 1.Extracranial stent group was successful in 20 cases,failure in 1 case,the success rate of 95.2%.The reocclusion 1 cases,heart rate,blood pressure,a decrease of 5 cases.Conclusion:Endovascular stenting surgery can be a good treatment of symptomatic cerebral artery stenosis,but the higher technical requirements,especially intracranial vascular stenting.And extracranial vascular stent angioplasty compared with intracranial vascular stent placement postoperative complications was relatively high.