目的 对比分析急性大脑中动脉闭塞行血管内再通与血管内再通结合缺血后处理2种治疗方法的安全性和效果.方法 选择急性大脑中动脉闭塞患者60例,根据患者家属治疗意愿分为单纯血管内再通治疗组(单纯治疗组)和血管内再通结合缺血后处理组(联合治疗组),每组30例.对比2组美国国立卫生研究院卒中量表(NIHSS)评分、发病24 h脑梗死体积和90 d良好预后率、脑卒中复发率及病死率.结果 2组发病24 h脑梗死体积明显高于术前,且联合治疗组发病24 h脑梗死体积[(3.6±1.3)ml vs (4.8±1.8)ml]、术后1、7、14 d NIHSS评分[(6.8±3.8)分vs (8.2±3.5)分;(2.6±1.6)分vs (4.0±1.8)分;(2.0±1.2)分vs (3.5±2.1)分]、90 d病死率(3.4％vs10.0％)显著低于单纯治疗组,术后90 d良好预后率(40.0％ vs 26.7％)明显高于单纯治疗组,差异有统计学意义(P＜0.05).2组术后90 d脑卒中复发率比较,差异无统计学意义(P＞0.05).结论 血管内再通结合缺血后处理治疗急性大脑中动脉闭塞是一种安全有效的措施,术后的神经功能缺损评分和脑梗死体积明显改善,其可降低术后再灌注脑出血发生率.

目的 探讨介入治疗锁骨下动脉闭塞的安全性和疗效.方法 回顾性分析32例锁骨下动脉闭塞病变患者行介入治疗的临床资料.应用导丝、球囊扩张及支架置入的方法经股动脉顺行穿刺和经桡动脉逆行穿刺进行开通.结果 30例开通成功,失败2例,成功率93.75％ (30/32),开通的30例患者症状、体征明显改善.介入治疗后患肢血压明显提高,患/健侧收缩压比由术前(0.68±0.12)mmHg提高至术后(0.98±0.15)mmHg,差异有统计学意义(t=8.585,P＜0.01).30例患者中26例术后随访3～50个月,2例术后出现再狭窄,再狭窄率为6.7％(2/30).结论 介入治疗锁骨下动脉闭塞病变是一种安全、有效的办法,可作为治疗的首选.

目的 探讨血管内支架治疗锁骨下动脉狭窄/闭塞合并相邻椎动脉起始部狭窄病变患者的疗效.方法 回顾性分析接受血管内支架治疗锁骨下动脉狭窄/闭塞合并相邻椎动脉起始部狭窄病变患者的临床资料,包括人口统计学特征、血管危险因素以及支架治疗和随访.结果 共纳入28例锁骨下动脉狭窄/闭塞合并相邻椎动脉起始部狭窄病变患者,其中男19例,女9例,平均年龄(65±9)岁.总的技术成功率为92.9％,其中锁骨下动脉狭窄合并相邻椎动脉起始部狭窄23例(82.1％),锁骨下动脉闭塞合并相邻椎动脉起始部狭窄5例(17.9％),有2例发生并发症,无介入相关的严重脑卒中和死亡.平均随访(24±18)个月,发生再狭窄3例和临床相关事件5例.术后12、24个月和随访结束时首次血管通畅率分别为92.4％、82.5％和78.8％,无临床相关事件存活率分别为92.5％、78.6％和70.5％.结论 血管内支架可安全和有效地治疗锁骨下动脉狭窄/闭塞合并相邻椎动脉起始部狭窄的患者.

目的 分析无创性经皮体外心脏起搏在高危颈动脉窦部狭窄支架成形术中应用的有效性和安全性.方法 对20例高危颈动脉窦部狭窄支架成形术应用无创性经皮体外心脏起搏治疗,其中男12例,女8例；年龄62 ～76(69±5.2)岁；对所有患者均行全脑血管造影和动态心电图检查,其中颈动脉窦部重度狭窄(狭窄率＞70％)15例,有心律失常10例,其中窦缓(R ＜50次/min)5例,缓慢心房纤颤3例,Ⅱ度Ⅰ型房室传导阻滞并心率均＜60次/min1例,交界性逸搏1例；对所有患者使用无创性经皮体外心脏起搏装置；重度狭窄患者支架置入前均行预扩张,预扩张后使用自膨式支架.结果 技术成功率为100％,残余狭窄均＜30％,所有患者术中均出现不同程度的心率、血压下降,心电监测上均有起搏脉冲钉样标记,所有患者均起搏成功,且无不良反应.结论 无创性经皮体外心脏起搏在高危颈动脉窦部狭窄支架成形术中应用是安全和有效的.

Objective To evaluate the middle cerebral artery (MCA) occlusion recanalization rate,clinical efficacy and safety of superselective intra - arterial thrombolysis (SIAT) combined with selective cerebral hypothermia protection.Methods The clinical datas of 13 cases of the MCA occlusion treatment by SIAT combined with selective cerebral hypothermia protection were retrospectively analyzed.Evaluation of recanalization with the TIMI degree; neural function of patients was evaluated by NIHSS score at 0 day,7 days,1 month and 3 months after treatment,as well as at 0 day before treatment ; prognosis of patients were evaluated by Rankin Scale (mRS) score and hemorrhagic transformation (HT).Results There were 9 patients whose middle cerebral artery was recanalization completely; 2 patients whose middle cerebral artery was recanalization partially; 2 patients whose middle cerebral artery was not recanalization.Followed up for 6 months,There were 6 patients who could take care of themselves cornpletely; 4 patients who could take care of themselves partially; 2 patients who could not take care of themselves completely; There were 1 patient who was died.There were 3 patients who happen to be cerebral hemorrhage after surgery.Conclusions SIAT combined with selective cerebral hypothermia protection for the treatment of the MCA occlusion is safe and effective.

Objective To investigate the corresponding relationship between the locations of hematoma and aneurysm in aneutysmal subarachnoid hemorrhage.Methods 50 patients with aneurysmal subarachnoid hemorrhage were detected by CT and DSA.The relationship between the locations of hematoma and aneurysm was analyzed.Results In the 50 patients,all of the 23 cases with anterior communicating artery aneurysms and anterior cerebral artery aneurysms in DSA were found hematoma in anterior longitudinal division in CT;18 cases(90.0%) of the 20 cases with carotid-posterior communicating artery aneurysms in DSA were found hematoma in basal cistern in CT;all of the 5 cases with middle cerebral artery aneurysms were found hematoma in lateral fissure in CT.Conclusion It is very valuable for the location of hematoma in patients with aneutysmal subarachnoid hemorrhage to judge the location of aneurysm.

目的 分析出血型烟雾病(MMD)的临床及影像学特征. 方法 回顾性分析20例出血型烟雾病的临床资料,观察其临床及影像学特点. 结果 本组患者主要集中在35～45岁年龄组,其中80%为女性.头颅CT扫描示脑室系统出血、脑实质出血及蛛网膜下腔出血;DSA表现为颈内动脉末端狭窄或闭塞,脑底烟雾状血管网、侧枝循环血管网以及动脉瘤形成. 结论 DSA检查是确诊烟雾病的主要方法,临床上对于无血管病变危险因素的脑出血患者均应常规行DSA检查.