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目的总结应用脑保护装置的颈动脉支架成形术的体会,并探讨其围手术期处理要点。方法 2002年1月至2007年12月共收治122例(125侧)颈动脉狭窄性病变患者,成功完成颈动脉支架成形术123侧,均使用了脑保护装置,共置入支架124枚。结果技术成功率为98.4%(123/125)。围手术期发生一过性脑缺血6例(4.9%),小卒中2例(1.6%),完全性卒中1例(0.8%),严重脑缺血再灌注损伤2例(1.6%),其余113例次(91.9%)无神经系统并发症发生。无围手术期死亡。总卒中/死亡率为2.4%。86例患者术后获随访,平均随访时间为18.5(3～36)个月,超声检查提示50%～70%狭窄5例(5.8%),70%以上狭窄1例(1.2%),均无临床症状。非相关原因死亡2例。其余78例(90.7%)支架通畅,无神经系统并发症发生。结论颈动脉支架成形术是治疗颈动脉狭窄性病变安全、有效的方法。不断提高围手术期处理水平是进一步提高疗效、降低并发症发生率的重要保证。
Objective To summarize the experience of carotid stenting using brain protection devices and to discuss the key points of its perioperative management. Methods From January 2002 to December 2007, 122 patients (125 sides) with carotid stenosis were enrolled. 123 cases of carotid stenting were successfully completed. All of the 124 cases were treated with brain protection device. Results The technical success rate was 98.4% (123/125). Perioperative cerebral ischemia occurred in 6 cases (4.9%), minor stroke in 2 cases (1.6%), complete stroke in 1 case (0.8%), severe cerebral ischemia-reperfusion injury in 2 cases (1.6% The remaining 113 cases (91.9%) had no neurologic complications. No perioperative deaths. Total stroke / death rate was 2.4%. Eighty-six patients were followed up for a mean of 18.5 months (range, 3-36 months). Ultrasonography revealed 5 cases (5.8%) with 50% -70% stenosis and 1 case (1.2%) with more than 70% stenosis. Clinical symptoms. Non-related causes of death in 2 cases. The remaining 78 cases (90.7%) stent patency, no neurological complications. Conclusion Carotid artery stenting is a safe and effective method for the treatment of carotid stenosis. Continuous improvement of perioperative management is to further improve the efficacy and reduce the incidence of complications an important guarantee.