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目的探讨应用颈动脉支架成形术(earotid artery stenting,CAS)治疗症状性颈动脉狭窄患者的可行性、安全性及疗效。方法对51例症状性颈动脉狭窄患者(其中颈动脉起始段狭窄48例,颅外段狭窄3例;狭窄程度50%～70%12例,70%～90%24例,≥90%15例)予以CAS治疗,共释放51枚支架,37例应用保护伞。结果全组技术成功率100%,术前平均狭窄率为79.8%,术后残余狭窄率<20%,18例保护伞中有碎屑。所有患者术后1周内症状及神经功能缺损体征有所改善。术中及术后发生心率减慢25例,血压下降17例,血管痉挛5例。随访2年,对糖尿病和高血脂患者3个月随访1次,51例患者均行颈动脉B超观察支架血管,每6个月1次,有6例复查了全脑血管造影,有3例出现轻度再狭窄,1例出现重度再狭窄;未发现支架移位、缺血性脑卒中。结论 CAS是治疗症状性颈动脉狭窄安全、有效的方法,严格掌握手术适应证和熟练操作可降低手术风险。术后及时随诊根据病情调整药物治疗方案是远期疗效的保证。
Objective To investigate the feasibility, safety and efficacy of carotid artery stenting (CAS) in patients with symptomatic carotid stenosis. Methods Totally 51 patients with symptomatic carotid stenosis (including 48 cases of carotid stenosis and 3 cases of extracranial stenosis; 12 cases of stenosis of 50% ~ 70%, 24 cases of 70% ~ 90%, ≥90% 15 Cases) CAS treatment, a total of 51 stent release, 37 cases of umbrella. Results The technical success rate of the whole group was 100%. The average preoperative stenosis rate was 79.8%. The residual stenosis rate was <20%. Debris was found in 18 cases of umbrella. All patients within 1 week after surgery symptoms and neurological deficits improved. Intraoperative and postoperative heart rate slowed down in 25 cases, 17 cases of decreased blood pressure, vasospasm in 5 cases. All cases were followed up for 2 years. Patients with diabetes and hyperlipidemia were followed up for 3 months. Fifty-one patients underwent carotid artery B-ultrasound to observe stent-vessel, once every 6 months. Six patients underwent total cerebral angiography and 3 patients Slight restenosis occurred in one case, and severe restenosis occurred in one case. Stent displacement and ischemic stroke were not found. Conclusion CAS is a safe and effective method for the treatment of symptomatic carotid stenosis. Strict surgical indications and skilled operation can reduce the surgical risk. Timely follow-up after surgery to adjust the drug treatment program is to ensure long-term efficacy.