动脉粥样硬化性颅内动脉狭窄的支架成形ppt课件.pptVIP

动脉粥样硬化性颅内动脉狭窄的支架成形 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 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 TIA的病理生理 大动脉狭窄型 栓塞型 腔隙型 混合型 进展 自然病程 药物治疗 WASID 支架治疗 首例 目前报道的小结 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 stenosisFeldman 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. 进展 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% 进展 多中心、随机对照研究 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;18:39–45. AJNR Am J Neuroradiol. 2005;26:2323–2327. 进展 Within peri-procedure Stroke and death 8.3% Annual stroke 3% - 5% Neurosurg Clin N Am. 2005;16:297–308. AJNR Am J Neuroradiol. 2005;26:525–530. 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;26:385–389. 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 arter