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血管内支架成形术治疗颅外段颈动脉狭窄

Carotid angioplasty and stenting for stenosis of extracraniai carotid artery

摘要:

目的:分析总结血管内支架治疗颅外段颈动脉狭窄的方法和并发症的预防.方法2001年10月至2008年6月共271例(300侧)颅外段颈动脉狭窄患者接受血管内支架成形术治疗,术前口服氯吡格雷75 ms/d,肠溶阿司匹林100~200 mg/d,辛伐他丁40 mg/晚,共5~10 d.应用肝素持续静脉滴注(50 mg/d)共2 d.术后继续抗血小板、降脂治疗.结果:271例患者(300侧)手术均获成功,颈动脉狭窄和脑缺血症状得到明显改善.术后1周内并发症7例,1例死亡.226例患者3~24个月行超声或数字减影血管造影,5例发生再狭窄;其中45例患者超声随访超过36个月,无再狭窄病例;所有病例随访期间无脑缺血相关症状发生.结论:血管内支架治疗颈动脉狭窄是安全有效的,正确的围手术期的处理以及娴熟的操作技巧是手术成功的关键.

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abstracts:

Objective To evaluate the operation method and prevention from complications of extracranial carotid stenosis. Methods Three cases of carotid angioplasty and stenting for 271 patients with extracranial carotid stenosis were performed from October 2001 to June 2008. Before the operation, take Clopidogrel for 75mg/d, Aspirin Delayed-Release Capsules for 100-200 mg/d, Simvastatin for 40 mg 1/ night, for 5-10 d. Then treat continuous vein infusion Heparin 50 mg/d for 2 d. After the operation, continue antiplatelet and reduce blood fat therapy. Results All 300 carotid stenting were successfully accomplished. DSA showed that the diameter of stenosed segment of carotid artery was markedly enlarged, and all clinical ischemia signs were improved remarkably. Seven cases suffered from complications in one week after operation and one died. Following up 3-24 months in 226 patients, restenosis were found in 5 cases, among which 45 patients were evaluated at follow-up by means of ultrasonic examination for 36 months or so, no restenosis was found. No ischemic attack occurred at follow-up. Conclusions The satisfactory effect and safety arc achieved in the therapy of carotid stenosis by carotid angioplasty and stenting. Correct pereoperative treatment and skilled techniques are the key points of success.

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作者: 王君 [1] 李宝民 [1] 李生 [1] 曹向宇 [1] 刘新峰 [1] 张阿兰 [1] 周定标 [1]
第一作者: 王君
期刊: 《中华外科杂志》2009年47卷6期 415-418页 MEDLINEISTICPKUCSCD
分类号: R5
栏目名称: 颈动脉粥样硬化性狭窄
DOI: 10.3760/cma.j.issn.0529-5815.2009.06.006
发布时间: 2009-05-12
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