血管内支架成型术治疗颈动脉狭窄66例(3)
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2010年5月1日
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(Figure 1a):the left internal carotic artery had bad stenosis,and the degree of stenosis was98%.(Figure 1b):After EV3's PROTEGERX self-expanding stent of 9mmX4cm,the stenosis vessele recovered normal.
3.DISCUSSION
Stroke is one of the three major diseases in China leading to human death,Ischemic stroke caused by carotid atherosclerosis accounted for 20% of all ischemic stroke,and had a poor prognosis.Traditional drug therapy of ischemic cerebrovascular disease had less effective,survival of 50~70% of the patients left hemiplegia,aphasia and other serious disability,and mposed a heavy burden on society and the family.With the development of minimally invasive technique,endovascular stent angioplasty treatment of carotid artery stenosis is a hot topic in recent years[3-4],it was the secondary prevention of stroke,and had a less trauma and a quick recovery.This group patients had good effect,the stenosis improved significantly immediately by cerebral angiography in operation.After operation,vascular ultrasound monitored the blood flow velocity returned to normal,the patient dizziness,seizures limb weakness,unresponsive and other cerebral ischemic symptoms improved significantly,recent follow-up data showed a good recovery and no severe complications.
10 cases had transient hypotension and heart rates decreased,28 cases had persistent hypotension and heart rates decreased among 66 cases of carotid artery stenting.The reasong may be carotid sinus baroreceptor stimulated by mechanical stimulation in stent placement or in the process of operation.Carotid sinus baroreceptor was in the carotid sinus vessel wall,it mainly felt the expansion of carotid sinus stimulation,catheter,guide wire in operationg may stimulate it (the longer operative time,right carotid sinus stimulation of the greater),stent continued stimulation after operation,all the reasons lead to hypotension and heart rate decreased[5-6].In this group there were 13 cases of stent diameter of optionswere greater than the normal carotid artery diameter of 1mm,the main reasong was that we did not plan to expand with balloon pre-or post-expansion,so used slightly larger stent,wanted to use the role of self-expandable stent in the artery to improve the carotid artery stenosis,ir can reduce the cost and shorten the surgery time and increases the adhesion of stent to the vessle,but increased the stimulation of carotid sinus,so the ratio of hypotension was relatively high ......
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