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目的探讨症状性锁骨下动脉近端重度狭窄或闭塞的血管内支架治疗的有效性和安全性。方法对42例经脑血管造影确诊的症状性锁骨下动脉近端重度狭窄或闭塞者行血管内支架治疗,回顾性分析手术成功率、围手术期与不同随访期内临床改善及并发症发生情况等。结果①手术情况:锁骨下动脉完全闭塞者(6例)血管再通及支架置入技术成功率83.3%(5/6)。锁骨下动脉近端重度狭窄者36例,支架置入技术成功率100%。41例行支架置入者术后即刻残余狭窄率均小于20%,且盗血现象完全消失;②围手术期情况:手术成功者术后临床症状和体征消失或明显好转。1例(2.4%)股动脉穿刺部位血肿,无严重并发症发生。③随访情况:随访期(1-6月)无症状复发及并发症发生,血管超声复查无支架内再狭窄及盗血现象。结论锁骨下动脉近端重度狭窄或闭塞的血管内支架治疗是安全有效的,且近期疗效值得肯定,但其远期疗效尚需进一步研究。
Objective To investigate the efficacy and safety of endovascular stenting for the treatment of symptomatic severe proximal subclavian artery stenosis or occlusion. Methods Forty-two patients with proximal severe stenosis or occlusion of symptomatic subclavian artery diagnosed by cerebral angiography were treated with endovascular stent. The success rate of surgery, clinical improvement and complications during perioperative period and follow-up period were analyzed retrospectively Wait. Results ①Operation: The success rate of the technique of revascularization and stenting was 83.3% (5/6) in the patients with complete subclavian artery occlusion (6 cases). 36 cases of severe proximal subclavian artery stenosis, stent implantation success rate of 100%. The residual stenosis rates of 41 cases of stents were less than 20% immediately after stenting, and the phenomenon of stealing blood completely disappeared. Peri-operative conditions: The clinical symptoms and signs disappeared or were obviously improved after successful operation. 1 (2.4%) femoral artery puncture site hematoma, no serious complications. ③ Follow-up: During the follow-up period (January-June), asymptomatic recurrence and complications occurred. There was no in-stent restenosis and steal of blood vessels after ultrasound examination. Conclusion The endovascular treatment of severe subclavian artery stenosis or occlusion is safe and effective, and the short-term curative effect is worthy of confirmation. However, its long-term curative effect needs further study.