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目的探讨血管内支架置入术治疗颈动脉夹层(CAD)的安全性和疗效。方法从南京卒中注册系统中,提取2005年5月—2010年12月经脑血管造影明确诊断的31例经抗栓治疗无效后行支架置入术的症状性自发性CAD患者的临床资料和随访数据。结果①在31例CAD患者中,30例支架置入手术成功,术中无并发症发生。术后即刻造影检查,29例CAD病变处狭窄完全消失,伴有夹层动脉瘤者动脉瘤明显缩小。2例患者于术后即刻出现术侧Horner征,其中1例伴有短暂性脑缺血发作(TIA),经抗栓治疗后完全缓解。②31例患者入院时NIHSS评分0分的有6例(19.4%,均为TIA患者),1～3分的有12例(38.7%),≥4分的有13例(41.9%),最高者1例为13分;中位数评分为2分。术后出院时NIHSS评分0分的有8例(25.8%),此8例患者入院时评分均≤4分。与入院时比较,有16例NIHSS评分无变化,占51.6%,且入院时评分均≤3分;有15例的评分呈不同程度下降,有2例2分者降为0分;下降最多的1例由13分降至4分;治疗前后评分的自身比较,采用McNemarχ2检验,χm2=14.062,P<0.01。③对29例手术成功的患者平均随访2.3年,无一例发生术侧血管缺血性事件。术后6～12个月对22例患者进行了DSA或CT血管成像的复查,CAD完全消失,无一例发生支架内再狭窄,伴有夹层动脉瘤者动脉瘤完全消失。结论血管内支架置入术治疗CAD是安全、有效的。
Objective To investigate the safety and efficacy of endovascular stenting in the treatment of carotid artery dissection (CAD). Methods The clinical data and follow-up data of 31 patients with symptomatic CAD undergoing stent implantation after embolectomy were excluded from Nanjing Stroke Registration System from May 2005 to December 2010 were collected. . Results ① In 31 cases of CAD patients, 30 cases were successfully placed in the stent. No complications occurred during operation. Angiography immediately after surgery, 29 cases of CAD lesions stenosis completely disappeared, accompanied by dissection aneurysm aneurysm was significantly reduced. Two patients showed Horner sign immediately after operation. One patient had transient ischemic attack (TIA), which was completely relieved after antithrombotic therapy. There were 6 cases (19.4%, all TIA patients) with NIHSS score 0 on admission in 31 patients, 12 (38.7%) in 1-3 and 13 (41.9%) in ≥4, the highest 1 case was 13 points; median score was 2 points. There were 8 cases (25.8%) of NIHSS score at 0 points after discharge, and the scores of these 8 cases were ≤4 points on admission. Compared with admission, there were 16 cases of NIHSS score no change, accounting for 51.6%, and admission were ≤ 3 points score; 15 cases were decreased to varying degrees, 2 cases 2 points down to 0; the most declining 1 case from 13 points to 4 points; before and after treatment score their comparison, using McNemarχ2 test, χm2 = 14.062, P <0.01. ③ In 29 patients with successful operation, the patients were followed up for an average of 2.3 years. None of them had an ischemic event. Twenty-two patients underwent DSA or CT angiography at 6-12 months postoperatively. CAD completely disappeared and no stent restenosis occurred. All aneurysms with dissecting aneurysm completely disappeared. Conclusion Endovascular stenting for the treatment of CAD is safe and effective.