大动脉炎所致脑缺血的管理

Management of cerebral ischemia due to Takayasu's arteritis.

作者信息

Wang Zhonggao, Shen Laigen, Yu Jun, Gu Yongquan, Wang Shihua, Guan Heng, Wu Qinghua, Zhang Xiaoming, Li Ming, Wu Jidong, Li Guoxing, Pan Songlin, Zhang Hongkun, Jin Wei

机构信息

Vascular Institute, General Post & Telecom Hospital, the Eighth Clinical College of Beijing University, Beijing 100032, China.

出版信息

Chin Med J (Engl). 2002 Mar;115(3):342-6.

PMID:11940360

Abstract

OBJECTIVE

To explore the management of cerebral ischemia caused by Takayasu's arteritis.

METHODS

Ninety-three cases treated from June 1984 to September 1999 at the General Post & Telecom Hospital, the Sir Run Run Shaw Hospital, the First Affiliated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hospital, including 10 men and 83 women, were reviewed. Of the 93 cases, bypasses from the ascending aorta to the axillary or subclavian artery and from graft to the carotid artery were performed in 47 cases. Subclavian to carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in five cases and stenting in one.

RESULTS

Marked improvement was achieved in 30.3%, fair in 34.9%, improvement in 21.2%, unchanged in 4.6%, and death in 9.0% before discharge; 30.6%, 38.8%, 16.3%, 4.1%, and 2.0% respectively during a mean follow-up of 48 months, and recurrence requiring revision in 8.2%.

CONCLUSION

Patients with occlusive lesions of all four cervical arteries always have severe cerebral ischemia and their distal runoff is always unvisualised by angiography. However, we found by exploration that the internal carotid artery is patent in all but one patient. Therefore, an ascending aorta to carotid bypass is feasible in most instances, and this can and should be done when the cerebral perfusion is jeopardized at a time when the patient is in a stable or relatively stable condition. Unfortunately, the cerebral re-perfusion syndrome is still a serious and not completely solved problem.

摘要

目的

探讨大动脉炎所致脑缺血的治疗方法。

方法

回顾性分析1984年6月至1999年9月在邮电总医院、浙江大学医学院附属邵逸夫医院、浙江大学医学院附属第一医院、北京大学第二医学院、北京安贞医院及北京协和医院治疗的93例患者，其中男性10例，女性83例。93例患者中，47例行升主动脉至腋动脉或锁骨下动脉及移植血管至颈动脉搭桥术；6例行锁骨下动脉至颈动脉搭桥术；5例行经皮腔内血管成形术（PTA），1例行支架置入术。

结果

出院前显著改善者占30.3%，好转者占34.9%，改善者占21.2%，无变化者占4.6%，死亡者占9.0%；平均随访48个月时，上述比例分别为30.6%、38.8%、16.3%、4.1%和2.0%，8.2%患者复发需再次手术。

结论

所有4条颈总动脉闭塞性病变患者均存在严重脑缺血，血管造影显示其远端血流均无法显影。然而，我们经探查发现，除1例患者外，其余患者颈内动脉均通畅。因此，在大多数情况下，升主动脉至颈动脉搭桥术是可行的，且当患者病情稳定或相对稳定且脑灌注受到威胁时，可以且应该进行该手术。遗憾的是，脑再灌注综合征仍然是一个严重且尚未完全解决的问题。