高危颈动脉狭窄的球囊扩张和支架植入术治疗

目的:探讨用球囊扩张和支架植入术(Carotid angioplasty and stenting,CAS)治疗高危颈动脉狭窄患者的疗效和并发症。方法:从2003年3月到2006年4月对8例高危的颈动脉狭窄患者进行CAS治疗,观察CAS的疗效和并发症。结果:对8例症状性颈动脉狭窄患者的9根颈动脉进行了CAS治疗。CAS术后9根颈动脉的平均狭窄率从75.4%显著减少到28.8%(P<0.001,配对t检验)。所有的患者都使用了脑保护装置。全部使用自膨式支架,其中大部分是Precise镍钛合金支架(77.8%)。术中5例患者发生了一过性心率减慢和血压下降。经过21.5±14.2(4~41)月的随访,所有患者没有再发卒中,除1例患者仍有轻度头晕外,其余患者头晕、眩晕症状全部消失。6例(75%)患者通过颈动脉超声和/或CTA随访发现支架通畅,无再狭窄。结论:采用脑保护装置的CAS是治疗高危颈动脉狭窄的安全可行的方法,但其疗效和安全性需要作进一步观察。

Carotid angioplasty and stenting in patients with high-risk carotid stenosis

OBJECTIVE: To investigate the efficacy and complication of carotid angioplasty and stenting (CAS) in patients with high-risk carotid stenosis. METHODS: Eight cases with high-risk carotid stenosis underwent CAS with cerebral protective devices from March 2003 to April 2006, the efficacy and complications of CAS were reviewed. RESULT: Nine stenotic carotid arteries of 8 cases were treated with CAS. Stenotic rate was significantly reduced from 75.4 % to 28.8% (P<0.001, paired t-Test) immediately after CAS. All stents used were self-expanding and most of them (77.8%) were precise nitinol stents. Five patients had mild and reversible low heart rate and blood pressure. During follow-up for 4-41 months (21.5+/-14.2), no case had stroke again, all except one had no dizziness or vertigo again. Ultrasonography and/or computed tomographic angiography showed no re-stenosis in six cases (75%) when they were followed up. CONCLUSION: CAS with cerebral protection device is a safe and feasible procedure to treat high-risk carotid stenosis. However,its long-term efficacy and safety need to be further studied.