血管内支架成形术治疗进展性TIAs初探
首都医科大学附属北京天坛医院急诊介入科 (100050)
背景：短暂性脑缺血发作(TIA)是完全性脑卒中的危险信号，而且发生完全性脑卒中的危险性大大高于无TIA的对照组。如未经任何治疗，1/3患者可能会在数年之内发生脑梗死，1/3患者经历反复发作而损害脑的功能。在临床上往往给予抗凝、抗血小板聚集等治疗。进展性TIA的特点是近期频繁发作，发作持续时间越来越长，药物治疗往往无效，发展为完全性脑卒中的危险非常大。近3年来，笔者对于这些病人，经过TCD、MRI、MRA、灌注CT和脑血管造影等检查，明确引起TIA的脑血管病变后，采取置入支架治疗狭窄的脑血管，以期达到终止TIA的发作，预防完全性脑卒中的发生。目的：通过总结21例采用血管内支架成形术的方法，治疗颅内、外脑血管狭窄引起的进展性TIAs，评价此治疗手段的安全性和有效性。
材料：2000年11月至2003年12月，在364例脑血管支架置入病例中，有21例患者是进展性TIAs患者，男17例，女4例，平均年龄61岁。病变部位：颈内动脉4例，大脑中动脉4例，椎动脉5例，基底动脉7例。病变性质：动脉夹层1例，动脉粥样硬化性20例。诊疗流程是：根据临床症状、实验室检查和影像学(CT 、MRI、MRA、灌注CT、TCD和DSA等)检查，遴选出低血流动力学性的病例，给予控制危险因素治疗(如戒烟、降脂、降糖、控制血压等治疗)、抗血小板治疗，NIHSS评分。一周后行血管成形治疗。对于进展性TIA的患者，如抗血小板治疗达不到1周，术前加1次大剂量抗血小板药，部分患者脑血管造影与支架置入术一次完成。术后进行NIHSS评分，继续抗凝、抗血小板治疗，控制血压和控制危险因素治疗。还要进行术后的影像学(TCD、灌注CT等)评价。了解缺血区是否恢复、有无高灌注现象等。
, 百拇医药
结果：21例患者中1例造影诊断基底动脉严重狭窄后，家属拒绝支架置入。手术技术成功率95.2%。术后19例患者缺血症状均缓解，术中和术后围手术期内无并发症发生。1例因拒绝支架置入，1天后死亡，1例因术后血压控制不好，造成珠网膜下腔出血，10天后死亡。
结论：血管内支架成形术治疗颅内、外脑血管狭窄引起的进展性TIA的方法是安全性而有效性的。
Initial Experience in Treatment of Crescendo Transient Ischemic Attacks with Endovascular Stent Angioplasty
DU Bin , JIANG Weijian
Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing, China.
, 百拇医药
Background: A transient ischemic attack (TIA) is a danger signal for stroke. Compared with patients without a history of TIA, patients with a history of TIA have much higher risk of a completed stroke. For patients experience a TIA, if left untreated, one third would suffer a stroke within a few years and another one third develop brain damage due to recurrent TIAs. Clinically patients with TIAs are often tereated with anti- coagulants and antiplatelet agents. Crescendo TIA is characterized by multiple recurrent episodes of TIA over hours to days, longer duration of symptoms, and often unresponding to medical treatment alone. Patients with crescendo TIA are at even higher risk of stroke. Aggressive approachs with urgent surgical or endovascular intervention have been advocated for some of such patients in whom significant extra- or intracranial artery stenosis might be the cause. In the present study, we reported our three-year experience with 21 patients who underwent endovascular stenting of extra- and intracranial artery stenoses for crescendo TIA. Purpose: The aim of this study was to assess the safety and clinical efficacy of endovascular stenting of extra- and intracranial artery stenosis in patients with crescendo TIA.
, http://www.100md.com
Materials and Methods: During the period from November, 2000 to December, 2003, twenty-one out of 364 patients who underwent endovascular stenting of symptomatic extra- and intracranial artery stenoses were with a diagnosis of crescendo TIA, including 17 males and 4 females with a mean age of 61 years old. Location of the lesions: 4 were at internal carotid artery (ICA), 4 at middle cerebral artery (MCA), 5 at vertebral artery (VA), and 7 at basilar artery (BA), respectively. Nature of the lesions: 1 was dessection, and the remaining 20 atherosclerotic. The flow-chart of diagnosis and treatment were as follows: all 21 patients were with recurrent low-flow transient ischemic attacks (TIAs) and had a corresponding significant extra- or intracranial cerebral artery stenoses. Most of the patients underwent the procedure at least 1 week after treatment with antiplatelet and/or anticoagulant therapy, together with management of vascular risks. For some patients who received less than 1 week of medical treatment, a large dose of antiplatelet angents were given before the procedure. Before the procedure, neurological evaluation with NIHSS score, brain CT, MRI/MRA, transcranial Doppler (sonography or ultrasonography) (TCD), ultrasonography, CT-perfusion, and diagnostic cerebral angiography were performed in all patients. After the procedure, anticoagulants, antiplatelet agents, management of blood pressure were continued, and NIHSS scores and CT-perfusion were performed to assess whether there were improvement of perfusion or hyperperfusion in the previous ischemic areas.
, http://www.100md.com
Results: Successful placement of stent in all but one in whom a severe basilar artery stenosis was confirmed by cerebral angiogram and stenting was refused by his family members. The technical successful rate was 95.2%. One patient who did not receive stenting died 1 day after admission, one patient who complicated with subarachnoid hemorrhage (SAH) after stenting died 10 days later.For the remaining 19 patients,there were no any periprocedural coplications and no further ischemic attacks during the follow-up period.
Conclusion: Endovascular stenting in the treatment of patients with crescendo TIA resulting from extra- and intracranial artery stenoses is safe and effective., http://www.100md.com(杜彬 姜卫剑)
背景：短暂性脑缺血发作(TIA)是完全性脑卒中的危险信号，而且发生完全性脑卒中的危险性大大高于无TIA的对照组。如未经任何治疗，1/3患者可能会在数年之内发生脑梗死，1/3患者经历反复发作而损害脑的功能。在临床上往往给予抗凝、抗血小板聚集等治疗。进展性TIA的特点是近期频繁发作，发作持续时间越来越长，药物治疗往往无效，发展为完全性脑卒中的危险非常大。近3年来，笔者对于这些病人，经过TCD、MRI、MRA、灌注CT和脑血管造影等检查，明确引起TIA的脑血管病变后，采取置入支架治疗狭窄的脑血管，以期达到终止TIA的发作，预防完全性脑卒中的发生。目的：通过总结21例采用血管内支架成形术的方法，治疗颅内、外脑血管狭窄引起的进展性TIAs，评价此治疗手段的安全性和有效性。
材料：2000年11月至2003年12月，在364例脑血管支架置入病例中，有21例患者是进展性TIAs患者，男17例，女4例，平均年龄61岁。病变部位：颈内动脉4例，大脑中动脉4例，椎动脉5例，基底动脉7例。病变性质：动脉夹层1例，动脉粥样硬化性20例。诊疗流程是：根据临床症状、实验室检查和影像学(CT 、MRI、MRA、灌注CT、TCD和DSA等)检查，遴选出低血流动力学性的病例，给予控制危险因素治疗(如戒烟、降脂、降糖、控制血压等治疗)、抗血小板治疗，NIHSS评分。一周后行血管成形治疗。对于进展性TIA的患者，如抗血小板治疗达不到1周，术前加1次大剂量抗血小板药，部分患者脑血管造影与支架置入术一次完成。术后进行NIHSS评分，继续抗凝、抗血小板治疗，控制血压和控制危险因素治疗。还要进行术后的影像学(TCD、灌注CT等)评价。了解缺血区是否恢复、有无高灌注现象等。
, 百拇医药
结果：21例患者中1例造影诊断基底动脉严重狭窄后，家属拒绝支架置入。手术技术成功率95.2%。术后19例患者缺血症状均缓解，术中和术后围手术期内无并发症发生。1例因拒绝支架置入，1天后死亡，1例因术后血压控制不好，造成珠网膜下腔出血，10天后死亡。
结论：血管内支架成形术治疗颅内、外脑血管狭窄引起的进展性TIA的方法是安全性而有效性的。
Initial Experience in Treatment of Crescendo Transient Ischemic Attacks with Endovascular Stent Angioplasty
DU Bin , JIANG Weijian
Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing, China.
, 百拇医药
Background: A transient ischemic attack (TIA) is a danger signal for stroke. Compared with patients without a history of TIA, patients with a history of TIA have much higher risk of a completed stroke. For patients experience a TIA, if left untreated, one third would suffer a stroke within a few years and another one third develop brain damage due to recurrent TIAs. Clinically patients with TIAs are often tereated with anti- coagulants and antiplatelet agents. Crescendo TIA is characterized by multiple recurrent episodes of TIA over hours to days, longer duration of symptoms, and often unresponding to medical treatment alone. Patients with crescendo TIA are at even higher risk of stroke. Aggressive approachs with urgent surgical or endovascular intervention have been advocated for some of such patients in whom significant extra- or intracranial artery stenosis might be the cause. In the present study, we reported our three-year experience with 21 patients who underwent endovascular stenting of extra- and intracranial artery stenoses for crescendo TIA. Purpose: The aim of this study was to assess the safety and clinical efficacy of endovascular stenting of extra- and intracranial artery stenosis in patients with crescendo TIA.
, http://www.100md.com
Materials and Methods: During the period from November, 2000 to December, 2003, twenty-one out of 364 patients who underwent endovascular stenting of symptomatic extra- and intracranial artery stenoses were with a diagnosis of crescendo TIA, including 17 males and 4 females with a mean age of 61 years old. Location of the lesions: 4 were at internal carotid artery (ICA), 4 at middle cerebral artery (MCA), 5 at vertebral artery (VA), and 7 at basilar artery (BA), respectively. Nature of the lesions: 1 was dessection, and the remaining 20 atherosclerotic. The flow-chart of diagnosis and treatment were as follows: all 21 patients were with recurrent low-flow transient ischemic attacks (TIAs) and had a corresponding significant extra- or intracranial cerebral artery stenoses. Most of the patients underwent the procedure at least 1 week after treatment with antiplatelet and/or anticoagulant therapy, together with management of vascular risks. For some patients who received less than 1 week of medical treatment, a large dose of antiplatelet angents were given before the procedure. Before the procedure, neurological evaluation with NIHSS score, brain CT, MRI/MRA, transcranial Doppler (sonography or ultrasonography) (TCD), ultrasonography, CT-perfusion, and diagnostic cerebral angiography were performed in all patients. After the procedure, anticoagulants, antiplatelet agents, management of blood pressure were continued, and NIHSS scores and CT-perfusion were performed to assess whether there were improvement of perfusion or hyperperfusion in the previous ischemic areas.
, http://www.100md.com
Results: Successful placement of stent in all but one in whom a severe basilar artery stenosis was confirmed by cerebral angiogram and stenting was refused by his family members. The technical successful rate was 95.2%. One patient who did not receive stenting died 1 day after admission, one patient who complicated with subarachnoid hemorrhage (SAH) after stenting died 10 days later.For the remaining 19 patients,there were no any periprocedural coplications and no further ischemic attacks during the follow-up period.
Conclusion: Endovascular stenting in the treatment of patients with crescendo TIA resulting from extra- and intracranial artery stenoses is safe and effective., http://www.100md.com(杜彬 姜卫剑)