动脉粥样硬化性颅内动脉狭窄的支架成形课件.ppt

动脉粥样硬化性颅内动脉狭窄的支架成形 大纲 颅内血管的特点 TIA的病理生理 进展 治疗 有待探讨的问题 颅内血管的特点 血管与其相应供血区的关系 血管壁的结构 穿支的问题 血管走行特点 TIA的病理生理 大动脉狭窄型 栓塞型 腔隙型 混合型 进展 自然病程 药物治疗 WASID 支架治疗 首例 目前报道的小结 进展 第一例颅内动脉支架（1996年7月） 进展 进展 SSYLVIA Trial WINGSPAN Trial （prospective, multicenter study ） selfexpanding microstent 45 patients with stenoses 50% ipsilateral stroke or death rate of 30-d 4.4% 6-m 7.1% 进展 多中心、随机对照研究 进展 As technology and experience evolve, this procedure is becoming increasingly effective and safe for the treatment of intracranial atherosclerotic disease, and guidelines are being developed for its use. 进展 Within peri-procedure Stroke and death 8.3% Annual stroke 3% - 5% 进展 This procedure, however, remains hazardous with up to 50% of patients showing new, ipsilateral ischemic lesions on diffusion-weighted MR images. 进展 Intracranial angioplasty with or without stenting should be offered to symptomatic patients with intracranial stenoses who have failed medical therapy Similar to revascularization for extracranial carotid artery stenosis, patient benefit from revascularization for symptomatic intracranial arterial stenosis is critically dependent on a low periprocedural stroke and death rate and should thus be performed by experienced neurointerventionists 进展 Drug-eluting stents, although showing promise in coronary and canine vessels for the prevention of restenosis, are still not ready for human cerebral arteries because of differing histology and questions of drug neurotoxicity. 治疗 手术适应症 TIAs or stroke attributed to intracranial stenoses of ≥ 50% diameter reduction Evidences of atherosclerotic risk factors or dissection Evidences of decreased perfusion distal to the stenosis 治疗 狭窄率的测量 治疗 Determined by the following criteria First choice：The diameter of the proximal part of the artery at its widest, nontortuous, normal segment was chosen 治疗 Second choice：If th