颈动脉支架术后再狭窄的处置VIP免费

颈动脉支架术后再狭窄的处理目录CONTENTS目录CONTENTS01定义02病例讨论03预防和治疗TheAffiliatedJiangningHospitalofNanjingMedicalUniversity01定义•颈动脉支架后再狭窄（in-stentrestenosis，ISR）：是指支架置入术后在支架处或支架边缘5mm范围内发生的＞50%的管腔狭窄。•当支架置入后发生再狭窄或参与狭窄＞50%时，发生缺血性卒中风险显著增高。TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02病例讨论一•患者张××，男，66岁•主诉：因“反应迟钝一天”入院。•既往有“高血压病”史多年，有长期烟酒嗜好。•查体：神志清楚，反应迟钝，混合性失语。记忆力、计算力欠佳。•NIHSS评分4分第一次住院：2014年11月23日TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02MRITheAffiliatedJiangningHospitalofNanjingMedicalUniversity02MRATheAffiliatedJiangningHospitalofNanjingMedicalUniversity02MRATheAffiliatedJiangningHospitalofNanjingMedicalUniversity02DSARAVTheAffiliatedJiangningHospitalofNanjingMedicalUniversity02RVA开口球扩支架4*13mm植入TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02RVA-V2段球扩支架4*13mm植入LVATheAffiliatedJiangningHospitalofNanjingMedicalUniversity02LVA开口球扩支架3.5*13mm植入TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02左侧颈动脉植入9*40mm自膨式支架TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02右侧颈动脉植入9*40mm自膨式支架TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02两年后，再次入院（2016-09-18）主诉：不能言语伴左侧肢体活动障碍2小时查体：左侧上下肢肌力5-级NIHSS评分6分•入院后2小时症状进行性加重•左侧上、下肢肌力0级TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02急查多模式MRI•CBV：轻度增高；CBF：明显下降；MTT及TTP稍延长；PWI明显大于DWI•判断：脑梗死前期Ⅰ2-Ⅱ1期TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02MRATheAffiliatedJiangningHospitalofNanjingMedicalUniversity02急诊介入手术3*20mm球囊预扩TheAffiliatedJiangningHospitalofNanjingMedicalUniversity023*20mm球囊预扩再次置入保护伞TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02置入6*20mm球扩支架•术后左侧肢体肌力恢复至5-级•NIHSS评分6分TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02术后第二天复查CTTheAffiliatedJiangningHospitalofNanjingMedicalUniversity02术后一周，患者出现夜间烦躁、精神症状，伴左肢肌力稍下降停用抗血小板药物加强脱水治疗TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02复查四天后七天后患者经治疗后症状好转出院NIHSS评分5分TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02病例讨论二患者陈××，男，63岁主诉：因“反应迟钝三天”入院。既往有“高血压病”史多年，八年前有“脑出血”病史，无明显后遗症。查体：神志清楚，口齿尚清。记忆力、计算力欠佳，右侧上下肢肌力5-级。NIHSS评分1分TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02MRITheAffiliatedJiangningHospitalofNanjingMedicalUniversity02颈部血管B超彩色多普勒：RCCA、LCCA斑块形成，RICA内径较窄，LICA血流速度慢存在脑大动脉狭窄？TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02DSA-2016.09.08RVATheAffiliatedJiangningHospitalofNanjingMedicalUniversity02RCCALVATheAffiliatedJiangningHospitalofNanjingMedicalUniversity02LCCATheAffiliatedJiangningHospitalofNanjingMedicalUniversity02LVA支架植入RICA支架植入TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02三个月后查头颈部CTA右颈支架上段扩张不良，管腔重度狭窄左颈C1段动脉瘤TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02左颈C1段动脉瘤TheAffiliatedJiangningHospitalofNanjingMedicalUniversity02CTP：双侧无...