| BaBackground and ObjectiveIschemic cerebrovascular disease is a clinical common disease, mainly in the elderly. Along with our country population aging, the incidence of ischemic cerebrovascular disease rate is increasing, and there is a younger trend. Caused by atherosclerotic vascular stenosis is an important cause of cerebral ischemia and stroke. In recent years, for the treatment of ischemic cerebral vascular disease make a spurt of progress, whether it is involved in drugs for the treatment of traditional or new development have made great progress, especially the interventional therapy, people drew the experience in the treatment of coronary ischemic disease, peripheral vascular disease and hemorrhagic cerebrovascular intervention, within a very short time in the technical feasibility and clinical efficacy, has made breakthrough progress. With the rapid development of neuroimaging, catheter technique and materials, computer science and so on, interventional techniques become more and more mature, and has become an important method of treatment of cerebrovascular disease, and gradually developed into an independent discipline.Interventional therapy of ischemic cerebrovascular disease refers to studies using intravascular catheter operation technology, the computer control of digital subtraction angiography (digital subtraction angiography, DSA) system, the involvement of human nervous system vascular disease diagnosis and treatment, a clinical medical science to embolism, dissolution, expansion, forming treatment the purpose of Ischemic cerebrovascular disease interventional diagnosis and treatment, can greatly reduce pain and disability rate, reduce the burden on families and society, get rid of the incidence of ischemic cerebrovascular disease rate is high, and the history of recurrent disease cycle, single drug in the treatment of ischemic cerebrovascular disease.Ischemic cerebrovascular disease interventional treatment technology is a new subject developing rapidly in recent 20 years. Although the application time of this technology in the cerebrovascular disease is short, the development is very rapid. A system of norms from clinical treatment, patient selection, intraoperative and postoperative medication, prevention of the complications of endovascular techniques in cerebral vascular diseases. Under the guide of radiological images, with the help of the catheter, balloon, stent expansion of excellent material of intravascular minimally invasive operation, can make the past that the refractory, can’t handle occlusion or severe stenosis of cerebral artery remodeling and recovered to normal, opened up a new therapeutic approach for the treatment of ischemic cerebrovascular disease. Because of small trauma, high safety, good effect, has become a shining star in medical circles, people pay more and more attention. At present, ischemic cerebrovascular disease with acute cerebral infarction intervention operation:super selective intraarterial thrombolysis, contact of intracranial venous sinus thrombosis, thrombolysis, interventional stenting for intracranial artery stenosis, extracranial artery (carotid artery, internal carotid artery, vertebral artery, subclavian artery, innominate artery) stenosis. At present, DSA has become the most important method for early diagnosis of ischemic cerebrovascular disease, has an important value in the PTAS guidance before operation and postoperative evaluation; PTAS is the treatment of ischemic cerebrovascular disease cerebral artery stenosis or occlusion of new and effective treatment, minimally invasive, safe, effective, short-term efficacy. Skilled and standard operation is the key to the success of the stent technology, with strict indications and experienced doctors operation treatment is safe.At present,1, in extracranial carotid atherosclerotic stenosis, treatment methods are commonly used drug treatment, operation treatment and endovascular interventional therapy, including operation treatment, including carotid endarterectomy (carotid endarterectomy, CEA), intracranial and extracranial vascular bypass grafting treatment, including angioplasty and stenting vessels intervention (carotid artery stenting, CAS), vascular intimal atherectomy, mechanical revascularization. Although surgical operation in the treatment of carotid atherosclerotic stenosis, carotid endarterectomy for relatively simple operation, the curative effect has been verified by 50 years of clinical practice, but China’s CEA due to various reasons at all levels of Hospital Department of neurosurgery is very limited, and the few randomized clinical studies have not shown a higher CAS risk than CEA, so CAS can become one of the main methods in the treatment of carotid atherosclerotic stenosis; 2, in the extracranial vertebral artery stenosis, Department of internal medicine curative effect standard drug therapy is not clear, and the surgical operation treatment of the complication rate is higher, its long-term effect is far better than endarterectomy for treatment of carotid artery stenosis, evidence based medicine although at present support vessels of extracranial vertebral artery stenosis angioplasty is not sufficient, but due to the limitations of drug treatment and surgical operation, the drug after treatment of ischemic events in patients may be considered underwent endovascular treatment, and vertebral artery atherosclerotic stenosis angioplasty and stent implantation are becoming research hot; 3, in the innominate artery and subclavian artery stenosis, the drug therapy Symptomatic atherosclerotic stenosis or occlusion of the patients, with the development of endovascular treatment technique and materials, by endovascular treatment of innominate artery and subclavian artery stenosis or occlusion has the advantages of less trauma, faster postoperative recovery, the clinical effect is satisfactory, has gradually replaced the artery bypass grafting, become the preferred treatment; 4, in the treatment of intracranial atherosclerotic stenosis, the current view is that for patients with symptomatic intracranial atherosclerotic stenosis, should first active drug treatment optimization, for drug refractory patients, such as clinical condition allows, collateral circulation is poor, the degree of stenosis≥70%, can consider endovascular treatment; 5, in the treatment of acute ischemic stroke, the only confirmed by evidence-based medicine effective treatment is intravenous thrombolysis, but intravenous thrombolytic therapy with a short time window, dissolve rate is low, re occlusion rate high, have a certain risk of bleeding and other shortcomings, and intravascular thrombolysis, mechanical thrombectomy device and arterial thrombolysis and mechanical embolectomy for clinical application, and further expansion of the acute ischemic stroke treatment Room window, recanalization rate, reduce the risk of bleeding; 6, intracranial venous sinus thrombosis, interventional therapy, the current lack of strong evidence that patients with intracranial venous sinus thrombosis using intravascular interventional treatment, but the anticoagulant and thrombolytic specification invalid patients, can consider to endovascular treatment, including sinus contact thrombolysis, mechanical thrombectomy, venous sinus stenting. In the world, about treatment guide each year in ischemic cerebrovascular disease has been updated, every new technology, new material, new therapies and new large-scale clinical research reports, and Chinese having the world’s largest cerebrovascular disease group, but we currently have no control on large clinical ischemic interventional therapy of cerebrovascular disease, in view of the lack of Chinese ischemic cerebrovascular disease interventional medicine level Ⅰ, level Ⅱ evidence based treatment. At the same time, China’s guidelines for interventional treatment of ischemic cerebrovascular diseases, also study abroad can only result. But attention is required, because the way of life, economic and cultural and racial difference, characteristics of the disease, cerebral vascular disease risk factors and long-term prognosis may be different, intracranial and extracranial atherosclerosis location, pathological characteristics may also vary, which will affect patients with intravascular interventional treatment of different benefit. In addition, the social and economic status of the patients may also influence the choice and interventional equipment whether can adhere to medication. The interventional therapy of cerebrovascular disease, should give full consideration to these factors, we can not completely copy the western research results. So far, endovascular techniques in western countries has experienced many years of development, has established the interventional technique training mechanism system, formed the interventional physician perfect qualification certification system, supervision and restriction system and medical insurance, the endovascular techniques into the track of healthy development. But in our country, although the development of neurovascular interventional techniques and clinical application has made considerable progress, some areas may also at the leading position in the world, but due to technical overall development time is short, the lack of perfect rules and regulations, no personnel training and qualification authentication system, therefore, this technology is often become the focus of the industry both inside and outside debate. To solve this problem, need different practitioners together, establish the cerebrovascular disease standard interventional techniques training mechanism, formulate feasible interventional physician qualification certification system in China, the neurovascular interventional technique towards rational, orderly development, for the benefit of the majority of patients.This paper discusses digital subtraction angiography (digital subtraction angiography, DSA) value superiority and etiological diagnosis of early diagnosis of ischemic cerebrovascular disease. At the same time of percutaneous transluminal angioplasty and stenting (percutaneous transluminal angioplasty and stenting, PTAS) in the treatment of cerebral ischemic diseases of the choice of indication, operation technique, efficacy and complications, a comparative analysis of clinical symptoms before operation, patients with changes of neural function and improve forward improved blood flow and cerebral blood perfusion, to explore the safety and effectiveness of PTAS operation; occurrence and control of PTAS therapeutic effect and complication of 100 patients.MethodsA review of 125 patients with ischemic cerebrovascular disease in our hospital from 2012 August to 2013 neurology in May to carry out the interventional therapy for ischemic cerebrovascular diseases hospitalized patients, all patients underwent carotid color Doppler flow imaging (color Doppler flow imaging, CDFI) transcranial Doppler ultrasound (transcranial Doppler, TCD), computed tomography (computerized tomography, CT), CT angiography (computed tomography angiography, CTA),CT perfusion imaging (computed tomography Perfusion, CTP), magnetic resonance imaging (magnetic resonance imaging, MRI), diffusion weighted imaging (diffusion weighted imaging, DWI), magnetic resonance angiography (magnetic resonance angiography, MRA), DSA examination, the comparison of different methods for the diagnosis of patients with value. Clear bow head neck artery (innominate artery,subclavian artery, C1 segment of internal carotid artery, vertebral artery V1 segment) and intracranial vascular (middle cerebral artery, basilar artery, intracranial segment of internal carotid artery and intracranial segment of vertebral artery)stenosis degree and preoperative evaluation, on the basis of ischemic cerebrovascular disease interventional treatment indications and contraindications card screened 118 vessels of 100 patients treated by PTAS, were successful stent implantation 119 stents. The immediate postoperative angiography and were followed up for 6 months-1 years, analysis of clinical efficacy and complications of interventional therapy in the treatment of DS A test results.ResultsIn 125 patients with DSA examination 1250 vessels were detected in 121 patients with vascular lesions, found a total of 301 branches, C1 segment of internal carotid artery in 73 branches,64 branches of the V1 segment of the vertebral artery, innominate artery in 4 branches,subclavian artery in 38 branches, intracranial artery in 122 branches (including middle cerebral artery in 43, basilar artery in 33, V4 segment of vertebral artery in 20, internal carotid artery C4 section 9, C6 section 11, C7 section 6. Vascular occlusion in 18 branches, more than 70% stenosis in 142, the degree of stenosis in 50～69% between the 57, the degree of stenosis of less than 50% 84.The degree of vascular lesions:the use of DSA found in patients with the most number of diseased vessels, there is significant difference compared with multi-slice spiral CTA and MRA examination, P< 0.05;Eventually pass strict screening,100 cases of symptomatic patients with severe atherosclerosis artery stenosis, consistent with interventional surgery indications, a total of 118 lesions in the artery, were successful stent implantation 119 stents. Postoperative symptoms were relieved or disappeared, improved nerve function, forward flow and cerebral perfusion improved significantly. Peri-operation period,13 patients with TIA and 8 showed obvious dizziness symptoms disappeared immediately or improved; 12 cases of internal carotid artery stenting was difficult to control hypertension significantly improved.1 cases of C1 segment of internal carotid artery in patients with V1 segment of vertebral artery stenosis and at the same time, stented after perfusion breakthrough cerebral hemorrhage,1 cases of basilar artery stent perforator events occurred,1 cases of middle cerebral artery stent implantation of vascular rupture,1 cases of V4 segment of vertebral artery stenting after acute coronary stent thrombosis.100 patients were followed up for 6 months-1 years, postoperative complications occurred in 4 patients, the adverse prognosis in 1 cases, and 3 cases by clinical treatment is almost back to normal, mild residual symptoms and signs of nervous system; the other 96 were not found in the treatment of vascular restenosis and related symptoms and signs of the nervous system.ConclusionThis study showed that cerebral angiography in the diagnosis of early ischemic cerebrovascular disease etiology is superior to the head and neck CTA and MRA,and after a system of norms from rigorous preoperative evaluation,especially assessment of the cerebral perfusion and collateral circulation,choosing appropriate equipments in operation,intraoperative and postoperative standard medication,the prevention and treatment of postoperative complications,and other aspect,PTAS is the treatment of ischemic cerebrovascular disease new and effective treatment treatment,minimally invasive,safe,effective,recent curative effect affirmation.PTAS makes past that can that the refractory, can’t handle occlusion or severe stenosis of extracranial and intracranial artery remodeling and returned to normal. |
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