血管内再通术治疗非急性动脉粥样硬化性颈内动脉颅外段闭塞的疗效观察

doi:10.3969/j.issn.1673-5765.2018.04.003

摘要/Abstract

摘要： 目的研究血管内再通术治疗非急性动脉粥样硬化性颈内动脉颅外段闭塞患者的安全性和有效性。方法对2015年3月-2017年5月入组的17例非急性动脉粥样硬化性颈内动脉颅外段闭塞患者行血管内再通治疗并连续随访。所有患者在围手术期均给予强化抗血小板药物治疗。采用数字减影血管造影（digital subtraction angiography，DSA）和改良Rankin量表（modified Rankin Scale，mRS）随访评价血管内再通的疗效和围手术期并发症，如过度灌注综合征、颅内出血、支架内血栓、夹层等。结果所有17例患者中，11例成功开通，6例未成功开通。17例患者临床随访中位时间为3（1，3，6）个月，术后6个月mRS中位数为1（0～4）分。术后6个月评估11例成功开通患者中有9例病情好转，2例稳定； 6例未成功开通患者中，1例病情好转，2例稳定，3例仍有缺血事件发作。7例接受影像随访的患者中，1 例出现支架内再狭窄。通过Wilcoxon秩和检验成功开通患者手术前后mRS评分比较，差异具有统计学意义（Z =－2.807，P =0.005）。所有患者在围手术期均未出现并发症。结论非急性动脉粥样硬化性颈内动脉颅外段闭塞患者行血管内再通治疗在技术上可行，患者短期预后改善明显，但远期疗效还有待进一步观察。

文章导读： 本研究旨在探讨血管内再通术用于非急性动脉粥样硬化性颈内动脉颅外段闭塞患者的安全性与中短期疗效，认为对非急性动脉粥样硬化性颈内动脉颅外段闭塞患者行血管内再通技术上可行，具有较高的安全性，可明显改善患者短期预后。

关键词: 动脉粥样硬化; 颈内动脉闭塞; 血管内再通; 介入治疗

Abstract:

Objective To investigate the safety and efficacy of endovascular revascularization in non-acute occlusion of extracranial internal carotid arteries. Methods From March 2015 to May 2017, 17 consecutive patients with non-acute occlusion of extracranial internal carotid arteries received endovascular recanalization therapy and continuous follow-up. All patients received medication for anti-platelet aggregation therapy before and after the operation. The perioperative complications, such as hyperperfusion syndrome, intracranial hemorrhage, stent thrombosis, dissection, etc, and recanalization efficacy were evaluated with the modified Rankin Scale (mRS) and digital subtraction angiography (DSA) follow-up, respectively. Results In all 17 patients, endovascular recanalization was successfully performed in 11 patients, and unsuccessfully performed in 6 patients. The median follow-up time of the 17 patients was 3 (1, 3, 6) months. Six months after the procedure, the median mRS scores were 1 (0-4). Six months after the procedure, the clinical condition of successful recanalization patients was improved in 9, and remained stable in 2; the clinical condition of unsuccessful recanalization patients was improved in 1, and remained stable in 2, which there was still an ischemic attack in 3. Follow-up check with imaging examination was performed in 7 patients, and restenosis occurred in 1 patient. A meaningful improvement in the modified Rankin Scale of successful patients during follow-up was suggested by Wilcoxon signed-rank test results (Z =-2.807, P =0.005). No complications were found in all patients during the perioperative period. Conclusion Endovascular revascularization for the non-acute atherosclerotic extracranial internal carotid artery occlusion is technically feasible, which can improve the short-term prognosis. However, the long-term outcomes need to be further investigated.

Key words: Atherosclerosis; Carotid artery occlusion; Endovascular revascularization; Interventional treatment

林喜喜, 张君, 王伟, 张金平, 孙丽丽, 郑梅梅, 赵伟, 宋云, 韩巨. 血管内再通术治疗非急性动脉粥样硬化性颈内动脉颅外段闭塞的疗效观察[J]. 中国卒中杂志, 2018, 13(04): 304-310.

LIN Xi-Xi, ZHANG Jun, WANG Wei, ZHANG Jin-Ping, SUN Li-Li, ZHENG Mei-Mei, ZHAO Wei, SONG Yun, HAN Ju. Curative Effect Observation of Endovascular Revascularization for Non-acute Atherosclerotic Extracranial Internal Carotid Artery Occlusion[J]. Chinese Journal of Stroke, 2018, 13(04): 304-310.

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