支架成形术治疗症状性颅内动脉狭窄的围手术期并发症及其处理

目的观察支架成形术治疗症状性颅内动脉狭窄的围手术期并发症,探讨围手术期并发症预防及处理方法。方法回顾性分析行支架成形术的71例症状性颅内动脉狭窄患者(76处病变,狭窄率≥50%),观察围手术期并发症及其发生率和经治疗后的临床结果。结果手术成功率96.1%(73/76),术后造影显示血管狭窄程度由术前的(79±8)%下降至(9±7)%。围手术期脑部并发症发生率11.8%(9/76),蛛网膜下腔出血3例,穿支闭塞2例,高灌注综合征1例,支架内血栓形成1例,动脉夹层2例。所有患者得到及时的处理,多数患者只遗留轻微症状。结论支架成形术治疗症状性颅内动脉狭窄效果确切,围手术期并发症发生率比较低,严格规范的围手术期管理、良好的操作技能对于预防手术并发症具有重要意义,及时对相关并发症进行合理处理,可以避免不良后果。

Perioperative complications of stenting for symptomatic intracranial artery stenosis and management

Objective To investigate the perioprative complications of stenting for symptomatic intracranial artery stenosis and probe into the methods of their prevention and management.Methods Seventy-one patients with symptomatic intracranial stenosis underwent angioplasty and stenting,the occurrence rate and therapeutic results of complications were observed.Results Stenting success rate was 96.1% （73/76 ）,post-operation angioplasty showed that the arterial stenosis was reduced from （79 ± 8 ）% to （9 ± 7 ）%.Perioperative complications involved 9 cases, accounting for 1 1.8%（9/76）,including subarachnoid hemorrhage（3 cases）,perforator stroke（2 cases）,hyper-perfusion syndrome（1 case） and artery dissection （1 case）.Some complications were relevant to improper periprocedural management.All patients received timely treatment,only slight lingering effects left.Conclusion Stent-assisted angioplasty is an effective technique for symptomatic intracranial arterial stenosis and its perioperative complications are relatively low.Reasonable perioperative management and good operating skills may help avoid surgical complications. It is of great importance to take reasonable treatment measures to avoid adverse consequences.