[1]王子亮,许岗勤,白卫星,等.颈动脉支架成形术后颅内出血临床分析[J].介入放射学杂志,2017,(12):1068-1072.
 WANG Ziliang,XU Gangqin,BAI Weixing,et al.Intracranial hemorrhage secondary to carotid artery stenting angioplasty: clinical analysis [J].journal interventional radiology,2017,(12):1068-1072.
点击复制

颈动脉支架成形术后颅内出血临床分析()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2017年12期
页码:
1068-1072
栏目:
神经介入
出版日期:
2017-12-25

文章信息/Info

Title:
Intracranial hemorrhage secondary to carotid artery stenting angioplasty: clinical analysis
作者:
王子亮 许岗勤 白卫星 薛绛宇 朱良付 李天晓
Author(s):
WANG Ziliang XU Gangqin BAI Weixing XUE Jiangyu ZHU Liangfu LI Tianxiao
Cerebrovascular Interventional Therapy Center, People’s Hospital of Zhengzhou University; Henan Provincial Interventional Treatment Center; Henan Provincial Center for the Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province 450003, China
关键词:
【关键词】 颈动脉狭窄 颅内出血 血管成形术
文献标志码:
A
摘要:
【摘要】 目的 探讨颈动脉支架成形术(CAS)后颅内出血的临床特点、发生机制及治疗。方法 回顾性分析2008年1月至2017年1月收治的颈动脉狭窄行CAS术患者,记录并分析术后出血患者临床及影像学资料。结果 513例患者中5例(0.97%)发生颅内出血,均经术后头颅CT/DSA证实。其中男3例,女2例,平均年龄(71.4±5.0)岁;颈动脉狭窄率为90%~99%,出血时间为术中即刻至术后10 d;1例DSA显示同侧基底节区烟雾血管,1例DSA发现穿支动脉出血。3例接受药物保守治疗,其中1例恢复良好,2例死亡;2例接受血肿穿刺引流,遗留偏瘫。结论 CAS术后颅内出血发生率较低,但致死、致残率较高。发病原因较多,术前充分评估、危险因素筛选可降低发生率。出血后积极控制血压,予以镇静、停用抗凝药、减少/停用抗血小板药以及手术干预,可提高患者生存率。

参考文献/References:

[1] Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid?- artery stenosis[J]. N Engl J Med, 2010, 363: 11?- 23.
[2] International Carotid Stenting Study investigators, Ederle J, Dobson J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial[J]. Lancet, 2010, 375: 985?- 997.
[3] 卫 杰, 刘洁怡, 耿昌明, 等. 颈动脉支架成形术治疗重度颈动脉狭窄25例效果分析[J]. 介入放射学杂志, 2017, 26: 359?-3 63.
[4] Ogasawara K, Sakai N, Kuroiwa T, et al. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients[J]. J Neurosurg, 2007, 107: 1130?- 1136.
[5] Sundt TM Jr, Sharbrough FW, Piepgras DG, et al. Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia[J]. Mayo Clin Proc, 1981,56: 533?- 543.
[6] Timmers HJ, Wieling W, Karemaker JM, et al. Baroreflex failure: a neglected type of secondary hypertension[J]. Neth J Med, 2004, 62: 151?- 155.
[7] Macfarlane R, Moskowitz MA, Sakas DE, et al. The role of neuroeffector mechanisms in cerebral hyperperfusion syndromes[J]. J Neurosurg, 1991, 75: 845?- 855.
[8] Chamorro A, Vila N, Obach V, et al. A case of cerebral hemorrhage early after carotid stenting[J]. Stroke, 2000, 31:792?- 793.
[9] 李 生, 李宝民, 周定标, 等. 颈动脉狭窄支架成形术围手术期颅内出血原因及防治[J]. 中华外科杂志, 2010, 48: 582?- 584.
[10] 牟 凌, 顾斌贤, 王 武, 等. 颈动脉支架成形术后肝素与低分子肝素抗凝效果和安全性比较[J]. 介入放射学杂志, 2013,22: 972?- 975.
[11] Lee KJ, Kwak HS, Chung GH, et al. Leptomeningeal collateral vessels are a major risk factor for intracranial hemorrhage after carotid stenting in patients with carotid atherosclerotic plaque[J]. J Neurointerv Surg, 2016, 8: 512?- 516.
[12] Friedman JA, Kallmes DF, Wijdicks EF. Thalamic hemorrhage following carotid angioplasty and stenting[J]. Neuroradiology, 2004, 46: 399?- 403.
[13] Morrish W, Grahovac S, Douen A, et al. Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis[J]. AJNR Am J Neuroradiol, 2000, 21: 1911?- 1916.
[14] Abou?- Chebl A, Yadav JS, Reginelli JP, et al. Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting: risk factors, prevention, and treatment[J]. J Am Coll Cardiol, 2004, 43: 1596?- 1601.
[15] 徐跃峤, 缪中荣, 王 宁, 等. 颈动脉支架置入术后颅内出血的临床分析[J]. 中国脑血管病杂志, 2009, 6: 119?- 123.
[16] Abou?- Chebl A, Reginelli J, Bajzer CT, et al. Intensive treatment of hypertension decreases the risk of hyperperfusion and intracerebral hemorrhage following carotid artery stenting[J]. Catheter Cardiovasc Interv, 2007, 69: 690?- 696.
[17] van Mook WN, Rennenberg RJ, Schurink GW, et al. Cerebral hyperperfusion syndrome[J]. Lancet Neurol, 2005, 4: 877?- 888.
[18] Ogasawara K, Mikami C, Inoue T, et al. Delayed cerebral hyperperfusion syndrome caused by prolonged impairment of cerebrovascular autoregulation after carotid endarterectomy: case report[J]. Neurosurgery, 2004, 54: 1258?- 1261.
[19] Haug M. Hyperperfusion syndrome following carotid revas?- cularization: a subject for the family doctor[J]. Zentralbl Chir, 2007, 132: 187?- 192.

相似文献/References:

[1]石 潆,赵 卫,沈 进,等.脑动静脉畸形栓塞治疗术并发颅内出血的原因及处理[J].介入放射学杂志,2012,(03):185.
 ,,et al.Intracranial hemorrhage due to embolization therapy for cerebral arteriovenous malformation: its causes and management [J].journal interventional radiology,2012,(12):185.
[2]朱文燕,陈燕华,古振云,等.颈动脉支架术后并发症——高灌注综合征九例的护理[J].介入放射学杂志,2014,(08):729.
 ZHU Wen yan,CHEN Yan hua,GU Zhen yun,et al.The nursing care for patients with hyperperfusion syndrome occurring after carotid artery stenting; initial experience in 9 cases[J].journal interventional radiology,2014,(12):729.
[3]沈文俊,李秋平,李昊.儿童期颅内动静脉畸形临床及形态学分析[J].介入放射学杂志,2014,(07):557.
 SHEN Wen jun,LI Qiu ping,LI Hao..Clinical and morphological analysis of intracranial arteriovenous malformation in childhood[J].journal interventional radiology,2014,(12):557.
[4]李 菁,韩冰莎,贺迎坤,等.重度颈动脉狭窄腔内支架植入术后认知功能临床研究[J].介入放射学杂志,2015,(11):943.
 LI Jing,HAN Bing- sha,HE Ying- kun,et al.Clinical study of the cognitive function after stent implantation for severe carotid stenosis[J].journal interventional radiology,2015,(12):943.
[5]梁晓东,汪勇锋,李天晓.抗血小板药物诱导颅内多发出血1例[J].介入放射学杂志,2016,(04):285.
 LIANG Xiao- dong,WANG Yong- feng,LI Tian- xiao.Intracranial multiple hemorrhages induced by antiplatelet agents: report of one case[J].journal interventional radiology,2016,(12):285.
[6]姚 晔,王 巍,李 琼,等.支架成形术治疗老年颈动脉狭窄效果及危险因素分析[J].介入放射学杂志,2016,(10):839.
 YAO Ye,WANG Wei,LI Qiong,et al.Stent angioplasty for carotid artery stenosis in the elderly: its curative effect and risk factor analysis[J].journal interventional radiology,2016,(12):839.
[7]王铭义,刘永晟,李 克,等.腔内治疗双侧颈动脉狭窄2例并文献复习[J].介入放射学杂志,2016,(12):1100.
 WANG Ming- yi,LIU Yong- sheng,LI Ke,et al.Endovascular treatment of bilateral carotid stenosis: report of 2 cases with literature review[J].journal interventional radiology,2016,(12):1100.
[8]吕 军,逯党辉,李 晋,等.急性缺血性卒中Solitaire AB支架取栓术后颅内出血并发症分析 [J].介入放射学杂志,2017,(05):390.
 LV Jun,LU Danghui,LI Jin,et al.Analysis of intracranial cerebral hemorrhage in patients after receiving rescue thrombectomy with Solitaire AB stent for acute ischemic stroke[J].journal interventional radiology,2017,(12):390.
[9]任红瑞,闫 磊,郭 栋,等.球囊扩张结合支架取栓治疗出血性颅内静脉窦血栓形成9例[J].介入放射学杂志,2018,27(05):396.
 REN Hongrui,YAN Lei,GUO Dong,et al.Balloon dilatation and mechanical thrombectomy with Solitaire stent for the treatment of hemorrhagic cerebral venous sinus thrombosis: preliminary results in 9 patients[J].journal interventional radiology,2018,27(12):396.
[10]潘文龙,赵 浩,王备备.颈动脉支架植入术患者的围术期护理[J].介入放射学杂志,2019,28(07):687.
 PAN Wenlong,ZHAO Hao,WANG Beibei..Perioperative nursing care for patients receiving carotid artery stent implantation: preliminary results in 97 patients[J].journal interventional radiology,2019,28(12):687.

备注/Memo

备注/Memo:
(收稿日期:2017-04-05)
(本文编辑:边 佶)
更新日期/Last Update: 2017-12-24