教培用血管内支架成型术治疗颈动脉狭窄课件

1、血管内支架成型术治疗颈动脉狭窄文档ppt血管内支架成型术治疗颈动脉狭窄文档ppt脑卒中及狭窄第三位致死疾病第一位致残疾病2030%的脑卒中由颈动脉狭窄引起 2000年进行的颈动脉内膜切除术超过150,000例，总计所有的支架成形术5210例我国每年新发脑卒中患者超过200万脑卒中及狭窄第三位致死疾病Basilar 65% BX 3.预防操作过程中的脑栓塞lateral view AP view follow 3mleft ICA 70% BX 4.Express 3.球囊扩张式支架 (Balloon Inflation Stent)R-CCA 58M TIA 90% L-CCAR-CCA 58

2、M TIA 90% L-CCA狭窄程度70%，但有明显的溃疡，或症状明确者M54, TIA, 82 mm in lengthR-ICA 60% TIAM54, TIA, 82 mm in length阿司匹林 325mg, 术前3天2000年进行的颈动脉内膜切除术超过150,000例，总计所有的支架成形术5210例手术治疗组2年脑卒中发生率 9%颈动脉内膜切除术有效-NASCET临床研究症状性狭窄超过70%的患者随机分组药物治疗组2年脑卒中发生率 26%手术治疗组2年脑卒中发生率 9%手术后脑卒中发生率降低的绝对值 17%，相对值65%Basilar 65% BX 3.颈动CEA手术示意图CE

3、A手术示意图PTAS (Percutaneous Transluminal Angioplasty and Stenting)血管内支架成形术PTAS (Percutaneous Translumina血管内支架成形术优点微创，容易被患者接受局麻下进行，便于监测神经功能操作上相对简单适合于危重患者适合于外科手术难以到达的病变C2水平以上，所有颅内，椎动脉适合于夹层引起的狭窄血管内支架成形术优点微创，容易被患者接受病人的选择有明确的TIA病史，或脑梗塞症状稳定后仍然有症状积极的药物治疗无法缓解血管狭窄程度超过70%狭窄程度70%，但有明显的溃疡，或症状明确者病人的选择有明确的TIA病史，或脑梗塞

4、症状稳定后仍然有症状术前检查及准备完整的神经系统检查脑CT, MRI （DW-MRI）抗血小板治疗阿司匹林 325mg, 术前3天脑血流动力学分析阿托品 0.5mg, 治疗前术前检查及准备完整的神经系统检查F59, TIA, headache Occlusion of R-ICAF59, TIA, headache Occlusion o教培用血管内支架成型术治疗颈动脉狭窄课件Easy wallstent 830，5mm BalloonEasy wallstent 830，5mm BallooPre- Post- Pre- M64 L-weakness 2 mosM64 L-weakness

5、2 mos教培用血管内支架成型术治疗颈动脉狭窄课件75% stenosis of L-ICA75% stenosis of L-ICAEasy Wallstent 960, 4mm balloon(1st) , 6mm ballon(2nd)Easy Wallstent 960, 4mm balloEasy Wallstent 960, 4mm balloon(1st) , 6mm ballon(2nd)Easy Wallstent 960, 4mm ballo12 M12 M R-CCA 58M TIA 90% L-CCA R-CCA 58M TIA 9 1st Balloon (3.5mm

6、) Easy Wallstent 1024, 2nd Balloon (5mm) 1st Balloon (3.5mm) Eas pre tx after stent post-angioplasty pre tx af lateral view AP view follow 3m lateral view AP vieF72, R-TIA, 70%, 5.2 cm in lengthF72, R-TIA, 70%, 5.2 cm in lenM54, TIA, 82 mm in lengthPre 1st stent 2nd stent Express 3.5X28 BX 3.5X23 M5

7、4, TIA, 82 mm in lengthPre M54, TIA, 82 mm longWallstent 624 Pre-Tx Post-TxM54, TIA, 82 mm longWallstent Before tx follow up 6m Before tx left ICA 70% BX 4.523 stent left ICA 70% Occlusion of R-ICABasilar 65% BX 3.手术治疗组2年脑卒中发生率 9%1st Balloon (3.Occlusion of R-ICAC2水平以上，所有颅内，椎动脉手术后脑卒中发生率降低的绝对值 17%，相对

8、值65%Before stenting血管狭窄程度超过70%pre tx after stent post-angioplasty脑CT, MRI （DW-MRI）R-CCA 58M TIA 90% L-CCA513 stent预防操作过程中的脑栓塞Easy Wallstent 960, 4mm balloon(1st) , 6mm ballon(2nd)lateral view AP view follow 3m手术治疗组2年脑卒中发生率 9%M44, SAH, Basilar Aneurysm, proximal stenosisEasy Wallstent 960, 4mm balloo

9、n(1st) , 6mm ballon(2nd) left ICA 70% BX 4.523 stentOcclusion of R-ICA left ICR-ICA 60% TIAR-ICA 60% TIAM60 Pcom Aneurysm, neck remnant, stenting and coilingM60 Pcom Aneurysm, neck remnanbefore dissectionafter dissectionbefore dissectionafter dissectBefore stentingAfter stentingBefore stentingAfter

10、stentingM73, TIA80%BX/CordisstentM73, TIA80%BX/Cordisstent Basilar 65% BX 3.513 stent Basilar 65% BX M44, SAH, Basilar Aneurysm, proximal stenosisM44, SAH, Basilar Aneurysm, pr L-MCA 85% M19 stenosis with aneurysm L-MCA 85% M19 stenos L-MCA 85% BX stent 2.5 13 L-MCA 85% BX stent 2M 63, L-ICA C2M 63, L-ICA C2支架种类自膨胀式支架 (Self Expandable Stent)Easy Wallstent (Schneider/BS)Smart Stent (Cordis)球囊扩张式支架 (Balloon Inflation Stent)Express (Boston Scitific)BX (Cordis/J&J)S670, S7 (MedtronicAVE)支架种类自膨胀式支架 (Self Expandable St球囊扩张式支架球囊扩张式支架自膨胀支架自膨胀支架预防操作过程中的脑栓塞支架远端球囊保护支架远端过滤装置带膜