[临床医学]刘新峰南京军区南京总医院神经内科_研究所_齐鲁医院_济南--动脉介入指南.pptVIP

* 脑动脉硬化性狭窄的介入治疗 --从指南到临床-- 刘新峰 Xinfeng Liu 南京军区南京总医院神经内科 南京大学神经病学研究所 Department of Neurology, Jinling Hospital Nanjing University School of Medicine Email: xfliu2@ ? 颅外段颈动脉病变 ? 颅外段椎动脉病变 ? 颅内动脉病变 颅外段颈动脉病变 ? CAS is indicated as an alternative to CEA for symptomatic patients at average or low risk of complications associated with endovascular intervention when the diameter of the lumen of the internal carotid artery is reduced by 70% by noninvasive imaging or 50% by catheter angiography (Class I; Level of Evidence B) 男，64岁，高血压， TIAs，记忆力下降1年。 无局灶性神经系统体征。DSA提示LICA 99%狭 窄，支架置入后上述症状明显缓解 ? Among patients with symptomatic severe stenosis (70%) in whom the stenosis is difficult to access surgically, medical conditions are present that greatly increase the risk for surgery, or when other specific circumstances exist, such as radiationinduced stenosis or restenosis after CEA, CAS may be considered (Class IIb; Level of Evidence B). CAS 适合于手术高危患者 男性，62 岁，发作性 意识丧失伴 左下肢无力1 月。既往有 高血压病史 15年，鼻咽 癌病史11 年，曾予以 多次放疗 LICA、 LCCA分别 予以支架置 入治疗 ? CAS in the above setting is reasonable when performed by operators with established periprocedural morbidity and mortality rates of 4% to 6%, similar to those observed in trials of CEA and CAS (Class IIa; Level of Evidence B). 围手术期的风险控制 The evaluation of CAS in symptomatic patients: EVA-3S, ICSS, SPACE, are outcome outliers 优化的药物治疗很重要 ? Optimal medical therapy, which should include antiplatelet therapy, statin therapy, and risk factor modification, is recommended for all patients with carotid artery stenosis and a TIA or stroke as outlined elsewhere in this guideline (Class I; Level of Evidence B). (New recommendation) 左侧颈内 动脉（R- ICA)闭 塞，经过 优化的药 物治疗半 年后， CTA复检 查显示血 管再通 Lxx,M-78y, RCCA近窦部闭塞,TIA发作3月,DSA示 RCCA上段闭塞,实施RCCA再通和RICA支架术 M-57y,反复左眼视物模糊,失语,右肢体无力。 造影示LICA闭塞，颅内部分经眼动脉部分代偿, 优化的药物治疗不能控制 7days post-stent LICA完全闭塞，C6 段以远经眼动脉少 量代偿（a） 经微导管证实，导 丝通过闭塞病变 后，用小球囊扩 张，血管再通，但 DSA可见L-ICA远端 较多血栓（b） 给予氯吡格雷＋阿 托他汀和肝素抗凝 治疗7d后，再次介 Pro- Post-stent