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弓上动脉狭窄的介入治疗

弓上动脉狭窄的介入治疗. 阜外心血管病医院心内科 蒋雄京 亚太介入心脏学会外周血管病组常委. 颈动脉狭窄与中风 — 中国. 中风新发病例 -- 200 万人 / 年 中风组成 -- 缺血性约占 50% 缺血性中风 -- 约 1/3 与颈动脉狭窄有关. 颈动脉狭窄的治疗. 药物治疗 外科治疗 endarterectomy ， standard ？ 美国手术病例 13 万 / 年 PTA+stent (CAS) --- 与外科比较优势如何？ --- 适应症？. 颈动脉内膜剥脱术并发症. 脑卒中/死亡: ECST: 7.5%

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弓上动脉狭窄的介入治疗

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  1. 弓上动脉狭窄的介入治疗 阜外心血管病医院心内科 蒋雄京 亚太介入心脏学会外周血管病组常委

  2. 颈动脉狭窄与中风 —中国 • 中风新发病例-- 200万人/年 • 中风组成--缺血性约占50% • 缺血性中风--约 1/3与颈动脉狭窄有关

  3. 颈动脉狭窄的治疗 • 药物治疗 • 外科治疗endarterectomy，standard？ 美国手术病例 13万/年 • PTA+stent(CAS) ---与外科比较优势如何？ ---适应症？

  4. 颈动脉内膜剥脱术并发症 • 脑卒中/死亡: • ECST: 7.5% • NASCET: 5.8% • ACAS: 2.3% • 脑卒中率 : 1.5 – 9% • 颅神经损伤: 7.6 – 27% • 颈部血肿 : > 5% • 伤口感染 : > 5% • 心血管事件: 2-4%

  5. 15 Carotid Stent Trials that have Ended Archer Archer2 Armour Sapphire Beach Security Cabernet Protect CREST Maverick Empire Space Epic ICSS EVA 3S

  6. MAE in High Risk Carotid Stent IDE Trials: 2002-2009 (n>4000) Remarkable decrease in MAE rates outside CREST • Source: William A. Gray MD, Presented at Oxford University, England • 7

  7. Perioperative stroke and death rate for CAS in symptomatic (fig.B) and asymptomatic (fig.D) patients

  8. Carotid Stent Trials still Ongoing CREATE-EV3 FREEDOM-GORE SAPPHIRE WWW-Cordis PROOF LOTUS ACST-2 SPACE-2

  9. Carotid Stenting at THI as of March, 2013 Technical success: [stent deployed] 98.6% Procedural Success: [left a residual < 30%] 98.4% Technical failure due to access &/or deployment 16 (1.3%) Major Procedural Complications (procedural and at 30 days) Stroke (Major) 11 (0.9%) and Cerebral Death 6 **(0.5%) TIA’s (Minor) 18* ( 1.5%) M.I. 4 (0.3%) Seizure/respiratory arrest 3 (0.2%) Length of hospital stay 1.26 days *1 Contralateral CVA **4Cerebral hemorrhage post CAS. Patients N=1035 Procedures N=1171 Vessels N=2057

  10. Stent selection for vulnerable plaque A) pre- and B) and C) postprocedural angiography of ulcerated lesion stented with the closed cell providing optimal plaque stabilization at the wall.

  11. Does Carotid Stent Cell Design Matter? closed-cell vs open-cell design stents.Schillinger, M. et al. Stroke 2008;39:905-909 Conclusions: Current data do not support the superiority of a specific carotid stent cell design with respect to neurologic complications, stroke, and mortality risk.

  12. 防止颅内栓塞的方式:

  13. 并发症学习曲线

  14. 同期双侧颈支架术的优缺点（与分期颈支架术比较）同期双侧颈支架术的优缺点（与分期颈支架术比较） • 优点: • 降低医疗费用 • 方便患者 • 不拖延其他外科手术时间 • 不必再次介入，缩短住院时间 • 缺点:更可能诱发 • 高灌注综合症 (HPS) • 血流动力学抑制 (HD)

  15. 同期双侧颈支架术研究：文献回顾

  16. Adverse events: all patients in FUWAI(30d and 6m after CAS)

  17. 30-day and 6-month hemodynamic events comparing UCAS group and SBCAS group

  18. Perioperative outcomes of carotid artery stenting in 237 patients with coexistent carotid and coronary artery disease Xiongjing Jiang, MD. Dept of Cardiology, Fuwai Hospital Peking Union Medical College Chinese Academy of Medical Sciences Bejing, China On behalf of peripheral intervention team

  19. End points

  20. Case presentation2008/5/14 CAG：LM+3 Vscheduled for CABG

  21. angiography

  22. 阜外医院颈动脉介入治疗的现状(2000-2012年, n=968)

  23. Left subclavian occlusion intervention

  24. 锁骨下动脉狭窄经皮介入治疗152例分析蒋雄京 等。中华心血管病杂志2007；35（4）：316-319.

  25. Thanks

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