Comparative Study Of Small Balloons Pre Expanding To The Starting Of Internal Carotid Artery With Severe Stenosis In Interventional Treatment's Curative Effect

Objective:To observe small balloon pre expansion technique in interventional treatment starting effect in patients with severe stenosis of internal carotid artery,and did not use a small balloon expansion of traditional operation curative effect comparison.Mainly in perioperative patients with high perfusion injury,cerebral hemorrhage,cerebral ischemic stroke,vagal reflex,the probability of cerebral vasospasm and preoperative and postoperative NIHSS two weeks score.And to do comparative analysis research,to confirm the small balloon pre expanding technology application security,effectiveness in stent angioplasty.Methods:Selection in December 2013-January 2015 start of symptomatic internal carotid artery of 104 patients with severe stenosis(stenosis degree?70%),including the group of 50 cases of small balloon pre expansion and a small balloon expanding group of 54 cases(control group).Two groups of patients admitted to hospital with stroke risk factors(hypertension,diabetes,high blood homocysteine,hyperlipidemia,etc.),gender,other factors,such as average age similar,comparative data between the two groups had no significant difference(P>0.05).All cases into groups exist symptomatic starting of severe stenosis of internal carotid artery stenosis rate of 75% or higher,there is no suitable blood vessels,severe bleeding tendency,merge intracranial placeholder or AVM,severe other system diseases,such as interventional treatment for the acute phase of cerebral infarction patients with contraindications to be ruled out,and the family members agreed to sign it.All into the group of patients with preoperative 3 to 5 days of oral clopidogrel 75 mg,300mg aspirin once a day;In another 2 hours within 48 hours,intraoperative and postoperative intravenous pumping maintain nim.Small balloon pre expanding group of patients with small balloon expansion technology to expansion of small balloon beforehand and then place the umbrella,0.5-1 hour observation,wait for after middle cerebral artery vascular bed filling.The pre expanding group without small balloon expansion steps,and placed directly umbrella,expansion of big balloon and stent implantation.Immediately after the review head CT,and TCD,NIHSS score.Six months after oral clopidogrel 75 mg/day,1 aspirin 300 mg/day,1 atorvastatin calcium 20 mg/1 night.Interventional treatment for 6 months after giving aspirin 100 mg/day,1 atorvastatin calcium 20 mg /1 night,until a lifetime.Postoperative neck vascular colour to exceed,TCD examination regularly 2 weeks,1/3/6 months,1 year line of head and neck CTA/DSA examination,head CT/MRI.Mainly recorded in the interention,perioperative intervention related complications,and preoperative and postoperative NIHSS score changes,another record number of postoperative patients with ischemic cerebrovascular disease occur within 1 year for comprehensive evaluation.Clinical follow-up by telephone,clinic and hospital medical records.To keep a record of the data carefully compared do after statistics processing.Statistical methods of measurement data with mean ± standard deviation,said two sample rate comparison between groups using X2 squared test,P<0.05 was statistically significant.Results:For small balloon pre dilation group 50 cases of patients with stent implantation was successful in all,support the preoperative average stenosis(84.2± 3.4%),preoperative average NIHSS(2.8±2.2),postoperative residual stenosis(8.6±3.2%)after operation 2 weekly average NIHSS was(2.5±2.0).The control group of 54 cases of patients with stent implantation operation in 53 cases of successful stent preoperative average stenosis(83.8±3.6%),and the preoperative average NIHSS(2.9±2.5),postoperative residual stenosis(9.2±3.0%),postoperative 2 weeks average NIHSS(3.2±2.8),of which 1 case because of the ball after the expansion of the blood pressure decreased with disturbance of consciousness without stent implantation.1 small balloon pre dilation group of stent implantation and peri operative period did not occur in the cerebral hemorrhage and reperfusion injury,vascular spasm and 1 cases(2.0%),the occurrence of TIA(transient ischemic attack)in 1 case(2.0%),about 10 minutes on their own ease and postoperative X-ray images not found new infarction foci,the occurrence of cerebral infarction patients,the occurrence of vagal reflex(2.0%).Non small balloon pre dilation group stent implantation surgery and peri operative period of cerebral hemorrhage in 3 cases(5.6%),high perfusion injury in 5 cases(9.3%),vascular spasm in 7cases(12.9%),TIA in 2 cases(3.7%),about 4-10 minutes self relief,postoperative X-ray images not found new infarct,cerebral infarction occurred in 1 cases(1.9%),the occurrence of vagal reflex in 7 cases(12.9%).The two groups of patients with in stent late restenosis rate and stroke rate statistics found no significance differences of P>0.05.And the two groups of patients,peri operative complications(cerebral hemorrhage,hyperperfusion,vasospasm,cerebral infarction,vagal reflex)and NIHSS score changes and analyzed statistically.The chi square test X2,P<0.05.have.Conclusion:1 Small balloon pre intervention treatment of severe stenosis of internal carotid artery stenosis is safe,patients with small balloon pre expansion group,after the operation did not appear serious complications and irreversible neurological deficits.2 Patients in the group of patients with small ball pouch were significantly smaller than those in the control group during the perioperative period,such as cerebral hemorrhage,high perfusion injury,blood vessel spasm,vagus reflex,and so on.3 For whether it can reduce intraoperative embolic loss probability caused by cerebral infarction due to peri operative period can lead to ischemic events more reasons,and correlated study sample was small,fewer cases of infarction results cannot be determined.