大动脉粥样硬化型缺血性脑血管病的手术和介入治疗_临床医学论文.docVIP

大动脉粥样硬化型缺血性脑血管病的手术和介入治疗_临床医学论文 大动脉粥样硬化型缺血性脑血管病的手术和介入治疗_临床医学论文 【摘要】 目的 评价大动脉粥样硬化 （Large-artery atherosclerosis，LA） 型缺血性脑血管病的手术和介入治疗效果，探讨合理有效的外科治疗与干预方案。 方法 回顾性分析56例LA型缺血性脑血管病病人的临床资料，其中反复TIA 36例，头晕或眩晕6例，不典型脑缺血症状14例。根据临床症状，行手术或介入治疗。根据术后临床症状改善情况，并对比手术前后影像学资料的变化，对手术或介入治疗效果进行评估。 结果 手术治疗24例，其中颈动脉内膜剥脱 （CEA） 7例，颅内外血管搭桥17例；介入治疗32例，其中颈、椎基底动脉系统支架成形26例，锁骨下及无名动脉支架成形6例。反复TIA病人中，1例CEA术后出现卒中事件，另1例术后死于心脏猝死，其余34例术后TIA症状消失；头晕或眩晕病人术后症状均改善；不典型脑缺血症状者术后影像学复查均获满意效果。 结论 对于LA型缺血性脑血管病，应积极采用手术及介入方法早期干预。手术和介入治疗在预防和治疗LA型缺血性脑血管病方面具有积极有效的作用。 【关键词】 脑缺血 动脉硬化 经外科手术 Abstract: Objective To evaluate the efficacy of neurosurgical and endovascular treatment for large-artery atherosclerosis-related ischemic cerebrovascular disease, and explore a reasonable and effective surgical and endovascular treatment protocol. Methods Clinical data of 56 patients with large-artery atherosclerosis-related ischemic cerebrovascular disease were analyzed retrospectively, including 36 cases presented with recurrent TIA, 6 with dizziness or vertigo, 14 with un-typical symptoms of cerebral ischemia. Surgical or endovascular treatment was performed according to their clinical symptoms. Based on the improvement of postoperative clinical symptoms and the changes of the postoperative imaging features, the efficacy of operation or intervention was assessed. Results Surgical treatments were performed in 24 patients, including 7 carotid endarterectomies (CEA) and 17 intracranial-extracranial bypasses. The percutaneous transluminal angioplasty and stenting (PTAS) was carried out for the carotid artery stenosis and cranial artery stenosis in 32 cases, of which carotid artery and vertebrobasilar artery stenoses were seen in 26 cases and subclavian artery and brachiocephalic trunk in 6. Of the 36 patients with TIA, there was no TIA or stroke event happened in the follow-up period, except 1 patient with complete stroke after CEA and another death as a result of heart failure in the CEA group. The symptoms of dizziness or vertigo were rel