脑血管病血管支架成形术课件

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1、脑血管病血管支架成形术研究进展武汉大学中南医院神经科刘煜敏有关症状性颈动脉狭窄CEA的三个大型实验NASCETECSTtheVeteransAffairsCooperativeStudyProgram.CEA的困境cranialorsuperficialnerveinjuryriskofastrokesmallriskofmyocardialinfarctionanaesthesia,increasingthepotentialforcomplications.feeExtracranial-intracranial(EC/IC)bypasssurgerywasnot

2、foundtoprovideanybenefitforpatientswithcarotidocclusionorthosewithcarotidarterynarrowingdistaltothecarotidbifurcation.176NeweffortsusingmoresensitiveimagingtoselectpatientswiththegreatesthemodynamiccompromiseforRCTsusingEC/ICbypasssurgeryareongoing.血管内治疗技术的优越性Toavoidsurgicalincision.Tore

3、quireonlylocalanaesthetic.Lesscostbecauseofashorterhospitalstay。LessMIWallstentTrialRandomized219symptomaticpatientswith60%to90%stenosistoCEAorCAS.withoutdistalprotectionandcurrentlyacceptedantiplateletprophylaxis.Studydesignallowedoperatorswithlimitedexperiencetoparticipate.Theriskofper

4、ioperativestrokeordeathwas4.5%forCEAand12.1%forCAS,andtheriskofmajorstrokeordeathat1yearwas0.9%forCEAand3.7%forCAS.ThetrialwashaltedbecauseofpoorresultsfromCAS.AlbertsMJ,Stroke.2001;32:325.SAPPHIRETheprimaryendpointofthestudyoccurredin20stentpatientsand32endarterectomypatients(30-dayrisk

5、,5.8%versus12.6%;P=0.004fornoninferiority).MostofthebenefitwasdetectedinthelowerriskofMIforthestentcomparedwiththehigh-surgicalriskendarterectomy.YadavJS,etal.NEnglJMed.2004;351:1493CAVATAS504例，251例行血管内治疗，253行外科治疗。55(26%)使用了支架，158(74%)仅适用球囊。独立的神经科医生随访病人.Lancet2001;357:1729–37only26%recei

6、vedstents.183Majoroutcomeeventswithin30daysdidnotdifferbetweenendovasculartreatmentandsurgerygroups。witha30-dayriskofstrokeordeathof10.0%and9.9%,respectively.Despitetheincreasedriskofsevereipsilateralcarotidstenosisintheendovasculargroupat1year,nosubstantialdifferenceintherateofipsilater

7、alstrokewasnotedupto3yearsafterrandomization.BaselinecharacteristicsOutcomeeventswithin30daysafterfirsttreatmentConclusionEndovasculartreatmenthadsimilarmajorrisksandeffectivenessatpreventionofstrokeduring3yearscomparedwithcarotidsurgery,butwithwideCIs.Endovasculartreatme