The Security For Intravascular Stenting Of Intracranial And Extracranial Carotid Stenosis

Objective: This study was to assessment the differences of risk for intracranial and extracranial vascular stenosis patients.We have observed the adverse reaction and complications related to stent angioplasty when perioperative period and a year after stent angioplasty,in order to provide useful information of preventing and reducing the risk in clinical treatment.Methods: 200 patients with ischemic cerebrovascular disease from2009~2012 in Cangzhou central hospital diagnosed cases in department of neurology have been divided into two groups,extracranial(100 cases)and intracranial(100 cases).The stenting points were all at the responsible vascular caused of ischemia incident.At last there was a statistics report on technical operations,postoperative complications and 1 year follow-up for two group respectively.Result:1 100 cases of extracranial technical operations are all successful in perioperative period,and 15 cases of operative complications showed blood pressure and heart rate decrease,ischemic stroke,subcutaneous hematoma,pseudoaneurysm,vagus reflex and transient brain ischemia;Among 100 cases of intracranial technical operations,97 cases were successful,2 cases dead and1 case have had percutaneous transluminal angioplasty after the stent implantation failure.Surgical success rate was 97%,the mortality rate was 2%.There were 17 cases of intraoperative complications,included ischemic stroke,artery dissection,vasospasm,respiratory and cardiac arrest.2 After the extracranial technical operations,the stenosis rate of patients was deduced from(75.68±7.32)% to(12.45±9.34)%;after the intracranial technical operations,the stenosis rate of patients was deduced from(74.93±11.33)% to(26.78±13.44)%.Both of them were improved than preoperative.3 The follow-up of the patients after extracranial technical operationsabout 1year showed that the rate of vascular occlusion was 2%(2/100),cerebral infarction was 3%(3/100),transient ischemic was 14%(14/100),cerebral hemorrhage was 1%(1/100).The follow-up of the patients after intracranial technical operations about 1year showed that the rate of vascular occlusion was 7.14%(7/98),cerebral infarction was 18.37(18/98),transient ischemic was 29.59%(29/98)and had none cerebral hemorrhage case.In the patients after extracranial technical operations,the rate of vascular occlusion,cerebral infarction,transient ischemic were lower than the patients after intracranial technical operations(P<0.05).4 The follow-up about the restenosis rate of all patients showed that there were 6 cases mild stenosis,3 cases moderate stenosis,and 1case severe stenosis in the patients after extracranial technical operations,the restenosis rate was 10%(10/100);there were 9 cases mild stenosis,10 cases moderate stenosis,and 3 case severe stenosis in the patients after intracranial technical operations,the restenosis rate was 22.45%(22/98).The restenosis rate of the patients after intracranial technical operations about 1year was higher than the patients after extracranial technical operations.5 The risk factors for intracranial and extracranial vascular stenosis patients showed that serum HCY level was proportional to the degree of arterial stenosis(P<0.01);hr-CRP level was proportional to the degree of arterial stenosis(P<0.05);HDL level was inversely proportional to the degree of arterial stenosis(P<0.05);LDL level was proportional to the degree of arterial stenosis(P<0.05).The result of Logistic analysis showed that diabetes mellitus and hypertension were the risk factors in intracranial and extracranial vascular stenosis.Conclusion: For intracranial vascular stent placement there is a certain degree of difficulty on technical operations and a certain risks,so the implementation of intracranial vascular stent placement should be cautious.For extracranial vascular stent placement the operatability is relatively larger,the success rate is higher,the risk is less.