出血性脑血管疾病缺血性.PPTVIP

崔源生 醫師 台中榮民總醫院神經外科 低侵入性治療概念Concepts of Minimal Invasive Surgery Outline: Carotid artery stenosis Endarectomy Carotid stenting Intracranial artery stenosis EC-IC bypass surgery Intracranial artery stenting Acute thrombosis IA thrombolysis 顱外缺血性腦梗塞-頸動脈狹窄 頸動脈狹窄-目前治療方式: Current Treatments 內科療法: 抗血小板藥物（Antiplatelet agents) 外科療法: 頸動脈內膜剝離術Carotid endarterectomy (CEA) 介入療法: 頸動脈支架術 PTA/Stenting 　　　　 w/distal embolic protection 頸動脈內膜剝離術（Carotid Endarterectomy） 頸動脈內膜剝離術-併發症 傷口血腫 傷口感染 迷走神經損傷 缺血性/出血性中風 心血管病變 Devices for Carotid Stenting Pre-CAS: Angiography Post-CAS: Angiography Pre-CAS CTA perfusion scan Post-CAS CTA perfusion scan 頸動脈支架術(Stenting) 優缺點： 優點 低侵襲性 不須全身麻醉適合高齡患者 可全程監控病人意識 不須暫時夾閉同側頸動脈 恢復期短 無手術相關併發症 無頸部傷口病患較舒服 缺點 追蹤期尚短 可能再狹窄率較高 血管壁可能受傷 可能無法完全撐開 血管太彎曲以致無法置放 VGH-TC results: CAS: 30 days any stroke/death Summary of CAS results 70 y/o female, TIA * * Interventional therapy of Ischemic Cerebrovascular disorder 缺血性腦血管疾病之外科介入性治療 出血性 腦血管疾病 缺血性 醫學材料之進步 臨床醫學經驗累積 影像-電腦醫學之進步 Symptomatic patients TIAs Ocular disorders Major stroke Asymptomatic patients Cervical bruit Multi-vascular disease Lower Stroke Risk US/MRA/DSA Stenosis 60% Stenosis 70% CEA or CAS 1. insertion 2. Deployment / pre-dilatation 3. stenting 4. retrieval Carotid Stenting with FilterWire Guiding Catheter PTA Balloon Captured Emboli CAS From 2005 to 2010, totally enrolled 232 cases with carotid stenosis s/p CAS 232 cases / 253 treated vessels M : F = 201 : 31 Age range: 42-89 y/o; Mean = 73.6 y/o Case: L/R/B: 101 /131/21 1.8% 0% 0% 3.5% 104 1 # 4 NA 1.7% 0.8% 1.7% 120 1 # 3 3.9% 6% 3.46% 0.86% Restenosis NA NA NA 0% AMI 0.49% 0% 0.86% 0.39% Death 0.94% 2% 4.21% 3.16% Any stroke 204 100 4757 232/ 253CAS Patients 1 1 36 1 Centers # 5 # 2 # 1 VGH-TC