我们用移植物支架治疗脑大动脉疾病的经验

D. Shchehlov, O. Svyrydiuk, О.I. Kravchik
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引用次数: 0

摘要

目的:探讨血管内支架治疗脑动脉病变的疗效和安全性。材料和方法。分析了6例(男3女3)采用支架治疗脑主干动脉病变的治疗结果。最小的病人35岁,最大的60岁。结果通过躯体和神经系统检查、选择性脑血管造影、计算机和磁共振成像资料进行评价。在发病后1 - 3个月内进行手术。在改良兰金量表中,4名患者得0分,2名得1分。所有患者在干预前接受双重解聚剂治疗,氯吡格雷75 mg,阿司匹林100 mg /天。用透射聚集体法测定氯吡格雷的灵敏度。所有干预均在全身麻醉下进行;干预时间为25 ~ 90分钟,平均45分钟。用于支架手术Atrium Advanta V12和graftmaster。其中4例支架植入没有技术困难。在两种情况下,由于支架系统的结构特点,特别是支架本身远端的刚性系统,限制了支架在弯曲区域的导航,从而产生了技术困难。在一个病例中,由于使用刚性输送系统和通过从引导导管逆行开口的方法植入支架,能够在动脉瘤水平植入。在一个病例中,支架植入时没有覆盖动脉的远端部分,支架植入后动脉瘤腔内发现造影剂停滞。6个月后对照血管造影显示动脉瘤从血流中完全排除。利用支架的特点,可以分离椎动脉和椎旁静脉丛之间的动静脉复合物,并完全重建动脉。无术中、术后并发症。患者住院时间3-5天。在所有病例中,除了动脉瘤脱离血流或动静脉分流断开外,动脉重建都得以实现。颅外颈动脉段动脉瘤使用支架移植的初步累积结果表明,该技术比“保守手术治疗”具有减少手术创伤、无颅神经损伤风险、住院时间短等优点。对于糜烂性出血和动静脉关节,应考虑使用支架移植作为一种选择方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Our experience with graft stents in the treatment of diseases of the main arteries of the brain
Objective – to study the efficacy and safety of stent grafts in the treatment of diseases of the cerebral arteries.Materials and methods. It was analysed results of treatment of 6 patients (3 men and 3 women) with disease of the main arteries of the brain, where stent graft was used. The youngest patient was 35 years old, the oldest was 60. Results were evaluated by data of somatic and neurological examination, selective cerebral angiography, computer and magnetic resonance imaging. Surgery performed within 1 to 3 months from the onset of the disease. On a modified Rankin scale four patients have 0 point, two have 1 point. All patients received double disaggregant therapy, clopidogrel 75 mg, and aspirin 100 mg per day before the intervention. Sensitivity to clopidogrel was determined by the method of light transmission aggregate. All interventions were performed under general anesthesia; the duration of the intervention ranged from 25 to 90 minutes, average mean was 45 minutes. Used for stent surgery Atrium Advanta V12 and Graftmaster.Results. In four cases, stent implantation had no technical difficulties. In two cases, technical difficulties arose due to the structural features of the stent system, in particular, the rigid system distal to the stent itself, which limits the stent navigation in curved areas. In one case, due to the use of rigid delivery system and implantation of the stent by the method of retrograde opening from the guide catheter was able to implant at the level of the aneurysm. In one case, the stent was implanted without covering the distal part of the artery, after stent implantation a stasis of contrast fluid in the aneurysm cavity was noted. Control angiography after 6 months to demonstrate total exclusion of an aneurysm from the bloodstream. Using the features of the stent, it was possible to separate the arteriovenous complicity between the vertebral artery and the paravertebral venous plexus with complete reconstruction of the artery. There were no intraoperative and postoperative complications. Duration of stay of patients in hospital 3–5 days. In all cases, reconstruction of the artery was achieved with the exception of an aneurysm from the bloodstream or disconnection of the arteriovenous shunt.Conclusions. The preliminary accumulated results of the use of stent grafts in the aneurysms of the extracranial carotid section indicate that this technique has advantages over “conservative surgical treatment” by reducing surgical trauma, no risk of damage to the cranial nerves, shorter stay time. In case of erosive bleeding and arteriovenous joints, the use of stent graft should be considered as a method of choice.
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