Transcript 出血性腦血管疾病缺血性

Interventional therapy of
Ischemic Cerebrovascular disorder
缺血性腦血管疾病之外科介入性治療
崔源生 醫師
台中榮民總醫院神經外科
腦血管疾病
出血性
缺血性
低侵入性治療概念
Concepts of Minimal Invasive Surgery
醫學材料之進步
影像-電腦
醫學之進步
臨床醫學
經驗累積
Outline:

Carotid artery stenosis
– Endarectomy
– Carotid stenting

Intracranial artery stenosis
– EC-IC bypass surgery
– Intracranial artery stenting

Acute thrombosis
– IA thrombolysis
顱外缺血性腦梗塞-頸動脈狹窄
頸動脈狹窄-目前治療方式:
Current Treatments
內科療法:
抗血小板藥物（Antiplatelet agents)
外科療法:
頸動脈內膜剝離術Carotid endarterectomy
(CEA)
介入療法:
頸動脈支架術 PTA/Stenting
w/distal embolic protection
Asymptomatic patients
Symptomatic patients
TIAs
Cervical bruit
Ocular disorders
Multi-vascular disease
Major stroke
US/MRA/DSA
Stenosis > 60%
Stenosis > 70%
CEA
or
CAS
Lower
Stroke Risk
頸動脈內膜剝離術（Carotid Endarterectomy）
頸動脈內膜剝離術-併發症

傷口血腫

傷口感染

迷走神經損傷

缺血性/出血性中風

心血管病變
Carotid Stenting with FilterWire
1. insertion
3. stenting
2. Deployment
/ pre-dilatation
4. retrieval
Devices for Carotid Stenting
PTA
Balloon
Guiding Catheter
Captured Emboli
Pre-CAS: Angiography
Post-CAS: Angiography
Pre-CAS CTA perfusion scan
Post-CAS CTA perfusion scan
頸動脈支架術(Stenting) 優缺點：
優點







低侵襲性
不須全身麻醉適合高齡患者
可全程監控病人意識
不須暫時夾閉同側頸動脈
恢復期短
無手術相關併發症
無頸部傷口病患較舒服
缺點





追蹤期尚短
可能再狹窄率較高
血管壁可能受傷
可能無法完全撐開
血管太彎曲以致無法置放
VGH-TC results:
CAS
From 2005 to 2010, totally
enrolled 232 cases with carotid
stenosis s/p CAS
232 cases / 253 treated vessels
M : F = 201 : 31
Age range: 42-89 y/o;
Mean = 73.6 y/o
Case: L/R/B: 101 /131/21
CAS: 30 days any stroke/death
100
80
60
40
20
0
Major stroke Minor stroke
2
1
RIND
Death
Good
5
1
244
Summary of CAS results
VGH- # 1
TC
#2
#3
#4
#5
Centers
1
36
1
1
1
1
Patients
232/
253CAS
4757
100
120
104
204
Any stroke
3.16% 4.21%
2%
1.7%
3.5%
0.94%
Death
0.39% 0.86%
0%
0.8%
0%
0.49%
AMI
0%
NA
1.7%
0%
NA
6%
NA
1.8%
3.9%
NA
Restenosis 0.86% 3.46%
Example# : Surgery+Endovascular
70 y/o female, TIA