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目的 评价伴对侧颈内动脉闭塞的高危颈内动脉狭窄病人血管内支架治疗疗效和安全性。方法 8例不适合颈动脉内膜剥脱的高危颈内动脉狭窄病人接受了血管内支架置入治疗。术前颈内动脉狭窄程度为 70 %～ 99% ,平均 (85 .2± 9.4 ) %。术前和术后 2 4h采用NIHSS评分 ,术前和术后 3个月采用改良Rakin评分标准对这些病人进行神经功能评分。术后随访 6～ 14个月。结果 术中造影证实 8枚支架均放置成功 ,残余狭窄程度 5 %～ 9% ,平均 (5 .3± 2 .2 ) % ,管腔狭窄程度较术前明显改善 (t=4 .79,P <0 .0 0 1)。术中没有发生与手术相关的并发症 ,术后 2 4h病人的NIHSS神经功能评分保持在术前水平 (2 .5± 2 .4 ) ;术后 3个月 ,改良Rakin神经功能评分 (1.13±0 .99)同术前 (1.2 5± 1.2 8)比较无显著差异 (t=1.89,P >0 .0 5 )。术后随访 6～ 14个月 ,除 1例偶发一过性脑缺血发作 (TIA)外 ,其他病人未再出现TIA和新的中风。结论 血管内支架置入术是治疗高危颈内动脉狭窄安全、有效的治疗手段
Objective To evaluate the efficacy and safety of endovascular stenting in patients with high-risk internal carotid artery stenosis with lateral internal carotid artery occlusion. Methods Eight patients with high risk of internal carotid artery stenosis unsuitable for carotid endarterectomy were treated with endovascular stenting. Preoperative carotid artery stenosis ranged from 70% to 99% with an average of (85.2 ± 9.4)%. NIHSS scores were used preoperatively and 24 h after surgery, and neurological function scores were assessed using modified Rakin score before and 3 months after surgery. The patients were followed up for 6 to 14 months. Results The intraoperative angiography confirmed that all the 8 stents were successfully placed. The residual stenosis ranged from 5% to 9%, with an average of (5.3 ± 2.2)%. The degree of stenosis was significantly improved compared with that before operation (t = 4.79, P <0 0 0 1). There was no surgery-related complications during operation. NIHSS scores of neurological function remained at the preoperative level at 24 hours after operation (2.5 ± 2. 4); at 3 months after operation, the scores of modified Rakin neurological function (1.13 ± 0 .99) compared with preoperative (1.2 5 ± 1.2 8) no significant difference (t = 1.89, P> 0.05). All cases were followed up for 6 to 14 months. TIA and new stroke were not found in other patients except for one case of recurrent transient ischemic attack (TIA). Conclusion Endovascular stenting is a safe and effective treatment for high-risk carotid artery stenosis