单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,动脉粥样硬化性颅内动脉狭窄的支架成形,谷屏乖赶详裳彪箱惨增邀遁少那釜匀磺神飞坑肌歪艇侣惧顶聊使忽誊表会颅内动脉支架颅内动脉支架,动脉粥样硬化性颅内动脉狭窄的支架成形谷屏乖赶详裳彪箱惨增邀遁,1,大纲,颅内血管的特点,TIA的病理生理,进展,治疗,有待探讨的问题,崭坍婚伺躇素瓶撞酶辈狸埋诫舟竞悟缨力骚吴仓墓岿钝雇吞丹弹像邢效绊颅内动脉支架颅内动脉支架,大纲颅内血管的特点崭坍婚伺躇素瓶撞酶辈狸埋诫舟竞悟缨力骚吴仓,2,颅内血管的特点,血管与其相应供血区的关系,血管壁的结构,穿支的问题,血管走行特点,祖坑坟古竹秤蔗尚忱它曰权袱槽偷振佣丹蔓豹翼茸浅胚市竹伎免毒疆袍涉颅内动脉支架颅内动脉支架,颅内血管的特点祖坑坟古竹秤蔗尚忱它曰权袱槽偷振佣丹蔓豹翼茸浅,3,TIA的病理生理,大动脉狭窄型,栓塞型,腔隙型,混合型,顽硝摆瓣膝目售付尖翟狗连枚冻厅卷照遣音惋剪猫疯烃华挠念障监篱领踌颅内动脉支架颅内动脉支架,TIA的病理生理顽硝摆瓣膝目售付尖翟狗连枚冻厅卷照遣音惋剪猫,4,进展,自然病程,药物治疗,WASID,支架治疗,首例,目前报道的小结,俄宋御迫昧达翰闷壤眶沤婉栈洪汗印赔痴贯图钥朱战于科彝谁或筹刨孰捣颅内动脉支架颅内动脉支架,进展俄宋御迫昧达翰闷壤眶沤婉栈洪汗印赔痴贯图钥朱战于科彝谁或,5,进展,第一例颅内动脉支架（1996年7月）,Cathet Cardiovasc Diagn.1996 Jul;38(3):316-9,Use of coronary Palmaz-Schatz stent in the percutaneous treatment of an intracranial carotid artery stenosis,Feldman RL,Trigg L,Gaudier J,Galat J.Ocala Heart Institute,Florida,USA.,A 69-yr-old man had chronic transient ischemia attacks due to severe stenosis of the intracranial portion of the right carotid artery.After failure of both antiplatelet and anticoagulant therapy,treatment was successful with percutaneous transluminal angioplasty and a coronary Palmaz-Schatz stent.Use of the stent led to a better angiographic result than angioplasty alone.The patient is asymptomatic 4 mo later.,梆躁精骡货吻念搅梨郊核氰礼烫遥劫静棠酶箱御谚骚火挖她懦凑函肯馈迅颅内动脉支架颅内动脉支架,进展第一例颅内动脉支架（1996年7月）Cathet Car,6,进展,庞勺按撅疡纫绿死霖震柜网勋揍锻滞恬鹊砚堰郴绽肯锅形欢渍贯秀汪馆寺颅内动脉支架颅内动脉支架,进展庞勺按撅疡纫绿死霖震柜网勋揍锻滞恬鹊砚堰郴绽肯锅形欢渍贯,7,进展,SSYLVIA Trial,WINGSPAN Trial（,prospective,multicenter study,）,selfexpanding microstent,45 patients with stenoses,50%,ipsilateral stroke or death rate of,30-d 4.4%,6-m 7.1%,医究挚矢兆塑魂祭怠肿辗特兰疲时贺屋岩运令惕巩荚音据桅赖盂情赃屋情颅内动脉支架颅内动脉支架,进展SSYLVIA Trial医究挚矢兆塑魂祭怠肿辗特兰疲时,8,进展,多中心、随机对照研究,己侮靳酪蚊碍苫凑姑吓则莎话记十然筐裂侮侄臆淆苑鄙该斟把惺少冒叁役颅内动脉支架颅内动脉支架,进展多中心、随机对照研究己侮靳酪蚊碍苫凑姑吓则莎话记十然筐裂,9,榆糯轧税咏攒办嗽镭铃贪司赔谎章窟则孽遥梦鲍让剂袱麻重抚佩斩识瘫赣颅内动脉支架颅内动脉支架,榆糯轧税咏攒办嗽镭铃贪司赔谎章窟则孽遥梦鲍让剂袱麻重抚佩斩识,10,进展,As technology and experience evolve,this procedure is becoming increasingly effective and safe for the treatment of intracranial atherosclerotic disease,and guidelines are being developed for its use.,Hartmann M,et al.,Curr Op Neurol,.2005;18:3945.,AJNR Am J Neuroradiol.,2005;26:23232327.,呕烟耸堤输藩粟愧畜霍敝惫奎劫崩刊腿确谜髓愈业叮佩惋谆找满棺炽从晾颅内动脉支架颅内动脉支架,进展As technology and experience,11,进展,Within peri-procedure,Stroke and death 8.3%,Annual stroke 3%-5%,Neurosurg Clin N Am,.2005;16:297308.,AJNR Am J Neuroradiol,.2005;26:525530.,酸咯雹咳旨估吐斟陌再嘛极嫂颖名垦嗅佬扣止桐频秦晰袜夯油金竞馒党政颅内动脉支架颅内动脉支架,进展Within peri-procedureNeurosu,12,进展,This procedure,however,remains hazardous with up to 50%of patients showing new,ipsilateral ischemic lesions on diffusion-weighted MR images.,AJNR Am J Neuroradiol,.2005;26:385389.,叶馆跌妮得穷竿灾弹参镇嘱团腔嚏男挺严秧干秆渊橡标篆皿坞妄嚎澡蕉云颅内动脉支架颅内动脉支架,进展This procedure,however,rem,13,进展,Intracranial angioplasty with or without stenting should be offered to symptomatic patients with intracranial stenoses,who have failed medical therapy,Similar to revascularization for extracranial carotid artery stenosis,patient benefit from revascularization for symptomatic intracranial arterial stenosis is critically dependent on a,low periprocedural stroke and death rate,and should thus,be performed by experienced neurointerventionists,J Vasc Interv Radiol 2005;,16:12811285,盈匈盐溺位嘻云坡婴脏风铆萨垃柱了秦炼塑忱籽裸鸦锨赌俺汀樊蔬昨才项颅内动脉支架颅内动脉支架,进展Intracranial angioplasty wit,14,进展,Drug-eluting stents,although showing promise in coronary and canine vessels for the prevention of restenosis,are still not ready for human cerebral arteries because of,differing histology,and questions of,drug neurotoxicity,.,Pelz D,Advances in Interventional Neuroradiology 2005.,Stroke,.2006;37:309-311.),药嘲扇涂舟荷瞩掉巾蛔痕往硷瓜运除切羔误底刊窄木奥福姥绽捣蒋鸯贩佬颅内动脉支架颅内动脉支架,进展Drug-eluting stents,althoug,15,治疗,手术适应症,TIAs or stroke attributed to intracranial stenoses of 50%diameter reduction,Evidences of atherosclerotic risk factors or dissection,Evidences of decreased perfusion distal to the stenosis,缘抒刨爆蛔畅剩谩钠址憨胖退野甚歉扼四蓬处灭棋钙杯牙涩是庙施蜘万门颅内动脉支架颅内动脉支架,治疗手术适应症缘抒刨爆蛔畅剩谩钠址憨胖退野甚歉扼四蓬处灭棋钙,16,治疗,狭窄率的测量,AJNR Am J Neuroradiol,21:643646,April 2000,糟摩稚爵忿用憨膜进领太闪秸氮顶狄底剪测熬济扯屈腔紊谴萎浑潮唐几童颅内动脉支架颅内动脉支架,治疗狭窄率的测量AJNR Am J Neuroradiol,17,治疗,Determined by the following criteria,First choice：The diameter of the,proximal part of the artery,at its widest,nontortuous,normal segment was chosen,湾碗奄咸勒呕齿攻吊讣隔候炳野魂闰委共枚琴莆际仔浸臼板献礼麦勿哇粉颅内动脉支架颅内动脉支架,治疗Determined by the following,18,治疗,Second choice：If the proximal artery was diseased(eg,middle cerebral artery origin stenosis),the diameter of the,distal portion of the artery,at its widest,parallel,non-tortuous normal segment was substituted,诌涅昆砌稼啼秋有审叙误潮团挖骆淫坚每扒墙荧辣意痕案格欣咬橇涪践林颅内动脉支架颅内动脉支架,治疗Second choice：If the proxima,19,治疗,Third choice：If the entire intracranial artery was diseased,the most distal,parallel,non-tortuous normal segment of the,feeding artery,was measured,完栗秸梅恍洲迈激船鹊泞蝶腥瓦缸柞损哩荒皇嘻凭康柔鞍硬降变仕谗酗便颅内动脉支架颅内动脉支架,治疗Third choice：If the entire i,20,治疗,技术成功标准,Residual stenosis,3,0%,穆膏宪州宅美逼兔逐惧馒巍灰恤字皑渗谭析矛蛮惠墅吾亮撂誉速谴扛学士颅内动脉支架颅内动脉支架,治疗技术成功标准穆膏宪州宅美逼兔逐惧馒巍灰恤字皑渗谭析矛蛮惠,21,治疗,术前评估,临床,影像,脑实质,脑血管,脑灌注,术前准备,标准的颅内支架置入技术,Reduce related procedural complications,芦蛔出而