頸動(dòng)脈狹窄的診斷、支架治療的病例選擇、圍手術(shù)用藥(存儲版)
【正文】 an Carotid Stenosis Trial (ECST) Results: Dramatic risk reduction with surgery for severe stenosis 結(jié)果 :CEA明顯降低頸動(dòng)脈嚴(yán)重狹窄患者的中風(fēng)危險(xiǎn)性 NASCET. N Engl J Med 1991。 114:683S–698S 頸動(dòng)脈狹窄的診斷 頸動(dòng)脈狹窄定義 Paul HL Kao ?頸總動(dòng)脈 (CCA)、分叉或頸內(nèi)動(dòng)脈(ICA) 近段動(dòng)脈硬化斑塊形成 ?斑塊潰瘍、血栓形成、或遠(yuǎn)端栓塞是引起癥狀 (TIA/stroke/AF)的主要原因 ?動(dòng)脈粥樣硬化 ?纖維肌發(fā)育不良 (fibromuscular dysplasia) ?高安氏病 （ Takayasu‘s Arteritis） ?血管炎（ vasculitis） (包括放療后 ) ?與神經(jīng)纖維瘤病相關(guān)的狹窄 頸動(dòng)脈狹窄的原因 臨床表現(xiàn) ?無癥狀性狹窄 無神經(jīng)系統(tǒng)癥狀和體征，影像學(xué)無陽性發(fā)現(xiàn) ?有癥狀性狹窄 Amaurosis fugax 一過性黑朦 Transient ischemic attack (TIA) Reversible ischemic neurological deficit (RIND)可逆性缺血性神經(jīng)功能神經(jīng)缺失 Completed stroke 完全中風(fēng) Bmode Power angio Color mapping Doppler TCD 頸動(dòng)脈狹窄的診斷 ?Duplex超聲 MRA amp。325:445453 ECST. Lancet 1991。 J. CHEST 1998。337:12351243 ?Contralateral occlusion 對側(cè) CCA閉塞 ?High or bifurcation lesions 高位或分叉部病變 ?Low or ostial CCA lesions 低位或靠近 CCA開口處 ?Neck radiation 頸部放射治療 ?Prior radical neck dissection 既往頸部切開術(shù) ?Prior carotid endarterectomy 既往 CEA ?Short, obese necks 頸部粗短 ?Spinal immobility due to congenital /acquired conditions 先天或后天性頸椎不穩(wěn)定 ?Additional stenoses involving the ipsilateral siphon伴隨有同側(cè)虹吸段狹窄 High anatomical risk for CEA Complications of ECA ? Stroke (between 1%5% after surgery) ? Myocardial infarction (leading c
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