医生课堂丨颈动脉狭窄了怎么办神经介入呵护

有效的白癜风偏方 http://www.baidianfeng51.cn/huanzhetiandi/xinqinggushi/174.html

人人爱美，希望有个“小蛮腰”，可如果颈动脉有个“小蛮腰”，那可就成了动脉狭窄了。中国心脑血管疾病流行学报告显示，脑卒中是我国城乡居民主要疾病死亡构成比中最主要的原因，其中约25%-30%颈动脉狭窄与缺血性脑卒中有着密切的关系，它的发生悄无声息，带来的后果极易致残、致死，所以也被称为“沉默杀手”。

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近期，青医院神经外科神经介入团队为多名颈动脉狭窄患者在局麻下成功实施了微创支架植入术，极大的降低了患者发生脑卒中的风险，患者全程清醒，在同医生交谈中轻松做完了手术。

图1：术前颈内动脉狭窄成“一线天”了；

支架植入术后狭窄解决完美血管通畅，

谁看谁舒畅！

图2、图3：颈内动脉两处斑块狭窄，

支架术后前向血流立马改善

图4：术前患者颈内动脉血管狭窄成了“锥口形”，支架植入术后患者血管通畅。

短的斑块千万不要放过，真要堵了出大事！

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颈动脉狭窄的临床表现

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长期慢性缺血造成脑损害，引起头昏、视力下降、智力和社会功能的下降等；

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狭窄部位可形成动脉粥样硬化斑块或附壁血栓，斑块或血栓脱落阻塞下游脑血管，轻者导致可恢复的短暂性脑缺血发作（TIA），可表现为突然发生头昏目眩，一侧眼暂时性发黑，胳膊、腿发麻无力，言语不清，一侧肢体无力，持物不稳，口角歪斜等，常于24小时内恢复；重者导致急性脑梗塞，引起永久性的偏瘫、偏身感觉、偏盲及语言功能的障碍等。

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为什么颈动脉会狭窄？

颈动脉狭窄的危险因素主要有以下几方面：高胆固醇血症、高血压、糖尿病、吸烟、体重超重与肥胖、精神紧张、高热量饮食、缺乏运动、老龄化等，男性多于女性。

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颈动脉狭窄的诊断与治疗

颈动脉狭窄的确诊需要依靠影像学检查，包括颈动脉超声、经颅彩色多普勒、CT血管成像（CTA）、磁共振（MRI和MRA）、数字减影血管造影（DSA）等。其中，数字减影血管造影（DSA）为检查的“金标准”。

颈动脉狭窄的手术治疗也有两种:颈动脉支架成形术（CAS）和颈动脉内膜剥脱术（CEA）。

今天单讲一讲颈动脉支架成形术（CAS）：

颈动脉支架成形术（CAS）是通过股动脉穿刺，将导管由动脉鞘置入，经髂动脉、主动脉逆向而上到达主动脉弓，再顺向选入颈动脉。利用球囊到达狭窄部位，把狭窄段扩张，再植入支架覆盖、支撑狭窄段。

颈动脉支架成形术（CAS）最大的优势就是微创，体表只在腹股沟留一个穿刺点，操作也不会引起明显疼痛，所以大部分可以在局麻下进行，也适用于身体情况较差（如某些高龄病人）、不能耐受全麻手术的病人。

如果患者颈部有过手术或放疗史，局部可能形成明显粘连，则不适合颈动脉内膜剥脱术（CEA）而适合颈动脉支架成形术（CAS）；如果狭窄部位很高，手术难以暴露，同样可以选择颈动脉支架成形术（CAS）；心脏冠脉支架植入术后的病人若劲动脉狭窄，要采用颈动脉支架成形术（CAS）。因为他们长期口服抗凝药物，如果行颈动脉内膜剥脱术（CEA），则需要停药，可能造成心肌缺血等后果。

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颈动脉支架植入动画演示

青医院神经外科脑血管病团队，倡导微创理念，在显微神经外科的基础上，积极开展各种神经介入技术，如介入支架取栓，颈动脉、颅内动脉狭窄介入和手术治疗，颅内动脉瘤的显微开颅夹闭和介入弹簧圈栓塞等，对颈动脉狭窄导致的一系列缺血性脑卒中治疗具有丰富经验。

供稿丨赵鹏、臧家蒙（神经外科）

?end?

乘车路线1：医院（南门）公交车站：

西3路，西5路，路，路，路，K21路

乘车路线2：医院（东门）公交车站：

西1路，西7路，西9路，西10路，路，路，路，路，路，路，路，K10路，K15路，K18路

西海岸新区

医院官微

长按扫码