分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄的疗效与安全性观察

doi:10.3969/j.issn.1673-5765.2020.08.011

摘要/Abstract

摘要：

目的观察分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄患者的疗效及安全性。方法回顾性分析2017年1-12月在西安交通大学第一附属医院神经内科连续住院的颈内动脉次全闭塞伴对侧颈内动脉狭窄患者的临床资料。采用分期治疗的方法，一期使用小球囊扩张次全闭塞侧颈内动脉，间隔2周后进行二期支架置入。观察手术技术成功率，手术成功指一期小球囊扩张后狭窄率减小，局部无夹层，且二期支架置入位置良好，残余狭窄率≤30%，前向血流mTICI 3级；围手术期并发症（包括高灌注综合征、脑梗死、TIA等）及死亡情况；随访1个月、3个月、6个月及3年的mRS评分，以及心脑血管事件和全因死亡。结果共纳入7例颈内动脉次全闭塞患者，平均年龄63.0±3.4岁，男性6例；其中6例为左侧，6例合并对侧颈内动脉狭窄≥50%。手术技术成功率100%（7/7），所有患者均未发生围手术期并发症及死亡。1个月随访时1例患者mRS评分为1分，其他6例均为0分，其余时间点所有患者均为0分，3年随访时1 例患者于术后1年发生冠心病。结论分期支架治疗在颈内动脉次全闭塞伴对侧颈动脉狭窄患者中相对安全，并对颈内动脉狭窄的改善明显。

文章导读： 本研究显示，在颈动脉次全闭塞伴对侧颈动脉狭窄患者手术策略上，分期支架置入可能是安全有效的方法。

关键词: 颈内动脉; 次全闭塞; 支架置入术; 高灌注综合征

Abstract:

Objective To explore the effectiveness and safety of staged carotid artery angioplasty and stenting in the treatment of patients with internal carotid artery (ICA) subtotal occlusion and contralateral ICA stenosis. Methods A retrospective analysis of the clinical data of consecutive patients with ICA subtotal occlusion and contralateral ICA stenosis in Department of Neurology of the First Affiliated Hospital of Xi'an Jiaotong University from January 2017 to December 2017 was performed. All patients were treated with staged treatment: a small balloon was used to dilate the subtotal occlusion ICA at stage 1, after an interval of 2 weeks, then ICA stent was implanted at stage 2. Observation indicators: the success rate of surgical technique (the surgical technique success means that stenosis degree was reduced at stage 1, with no local dissection, and the stent was placed in a good position at stage 2, with residual stenosis rate ≤30%, and the forward blood flow mTICI was grade 3), procedural complications (including hyperperfusion syndrome, cerebral infarction, TIA, etc.) and death; and clinical prognosis including 1, 3, 6-month and 3-year follow-up mRS score, cardiovascular and cerebrovascular events and all-cause mortality .

Results A total of 7 patients were enrolled, with a mean age of 63.0±3.4 years and 6 males; 6 of them were left side, and 6 had contralateral ICA stenosis ≥50%. The surgical technique success rate was 100% (7/7), and all patients had no peri-procedural complications or death. At 1-month follow-up, 1 patient had a mRS score of 1 and the rest were 0 points, and all patients had a mRS of 0 at the rest follow-up. At the 3-year follow-up, 1 patient developed coronary heart disease at 1 year after surgery. Conclusions Staged stent therapy is relatively safe for patients with ICA subtotal occlusion and contralateral ICA stenosis, which can significantly improve ICA stenosis.

Key words: Internal carotid artery; Subtotal occlusion; Carotid artery stenting; Hyperperfusion syndrome

陈晨，袁兴运，宋文峰，韩建峰，高凡. 分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄的疗效与安全性观察[J]. 中国卒中杂志, 2020, 15(08): 881-886.

CHEN Chen, YUAN Xing-Yun,SONG Wen-Feng, HAN Jian-Feng, GAO Fan. Clinical Efficacy and Safety of Staged Carotid Artery Angioplasty and Stenting for Patients with Internal Carotid Artery Subtotal Occlusion and Contralateral Internal Carotid Artery Stenosis[J]. Chinese Journal of Stroke, 2020, 15(08): 881-886.

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