穿支卒中与颅内动脉狭窄支架成形术.pdfVIP

厶 塞寸 志2007年12月第16卷第12期 J Intervent Radiol 2007，Vo1．16，No．12 · 综 述 General review· 穿支卒中与颅内动脉狭窄支架成形术 于丰萁， 洪 波， 刘建民 【摘要】 穿支卒中(PS)是颅内动脉狭窄支架成形术的一种并发症。颅内动脉存在较多的穿支动脉， 其闭塞可能导致致命性后果。根据冠脉血管的I临床研究，目前对Ps的机制有3种推论：雪梨效应、支架封 堵作用和血管内膜增生，并且在动物实验中也观察到了这3类现象。各治疗中心在治疗颅内动脉狭窄的 同时已经对Ps有所探讨。术前MRI提示患者存在I临近狭窄部位穿支梗死(PIAS)使得发生Ps的风险增 加。易发生Ps患者的特点还包括了狭窄的形态、部位、成因以及手术术式和手术器材选择。对于Ps的预 防仍然任重道远，而随着研究的深入，PS的机制也将逐步阐明。 【关键词】穿支卒中；雪梨效应；封堵作用；支架；I临近狭窄部位穿支梗死 中图分类号：R743、32 文献标识码：A 文章编号：1008．794X(2007)一12—0858—05 Perforator stroke and stenting of intracranial arterial stenosis YU Feng-qi， HONG Bo， LIU Ⅱ，】 _min． Department of Neurosurgery， Cerebrovascular Institute of Changhai Hospital， Second Military Medical Univers ，Shanghai 200433，China 【Abstract】 Perforator stroke(PS)is one of peri—procedural complications associated with stenting of intraeranial arterial stenosis． A lot of perforator arteries are derived from intracranial arteries with difference from coronary arteries， because once the intracranial perforator arteries of crucial regions are occluded， may lead to fatal proguosis．Three hypothesis have been used tO explain PS including snow—plowing，stent jailing effect and in—stent neointimal growth．In vivo models，investigators have already found these phenomenas．After much attention been paid on PS，authors have published a report covered with a large amount of cases in 2006． The author figured out that patients with perforator infarct adjacent tO the stenotic segment(PIAS)under MRI beforehand would have higher chance occurring PS after stenting of intracranial stenosis． Th e patients with priority of PS easily are affected by the morphology，location，etiology，sites，the type and equipments．Many yet unsolved problems including the prevention would arouse US to go deeper into for the exploration of the mechanism．(J Intervent Radiol，2007，16：858—862) 【