单侧颈动脉支架术与同期双侧颈动脉支架术的安全性比较课程.pptVIP

单侧颈动脉支架术与同期双侧颈动脉支架术的安全性比较 中国医学科学院 阜外心血管病医院心内科 蒋雄京  背 景 同期双侧颈支架术的优缺点（与分期颈支架术比较） 优点: 降低医疗费用 方便患者 不拖延其他外科手术时间 不必再次介入，缩短住院时间 缺点:更可能诱发 高灌注综合症 (HPS) 血流动力学抑制 (HD) 同期双侧颈支架术研究：文献回顾 Patient Population 234 patients with atherosclerotic severe carotid stenosis underwent CAS , 39 patients(16.7%) underwent SBCS between Jan.2005 and Dec.2009 Indication:60%(symptomatic)or80%(asymptomatic) Exclusion criteria : Non-atheromatous carotid artery stenosis such as Takayasu arteritis and fibromuscular dysplasia; new ischemic stroke within the previous six weeks; peripheral vascular disease precluding as the femoral artery access and any other illness that impeded their ability to provide informed consent. CAS Procedure Cervical-cerebral angiography to determine patency and the completeness of the circle of Willis. A distal embolic protection (filterwire EZ, Spider RX) was used in 233 of the 234 patients (99.6%). If the diameter reduction was ≥80%,the lesion was predilated by undersized balloon(3mm～4mm) Balloon expandable stents were deployed in the lesions located in the orifice of carotid common artery, while self-expandable stents in other lesions. The definition of procedure success :residual stenosis ＜30% and without severe complications during procedure Medical protocol Before the procedure : asprin(100mg/d) and clopidogrel(75mg/d) for at least 2 days plus a loading dose of clopidogrel(150mg) if patients were previously not on clopidogrel discontinued their regular antihypertensive medications and beta-blockers 12h before the procedure. During procedure: bradycardia :prophylactic atropine(0.5mg～1.0mg) hypotension :2mg～4mg of dopamine and treated with additional fluids After procedure: careful hemodynamic monitoring and vigilant monitoring for symptoms and signs maintain the systolic blood pressure between 100mmHg and 140mmHg 100 mg of aspirin once daily as a permanent medication and 75mg of clopidogrel once daily for at least 3 months after CAS pro