腦動脈支架治療相關(guān)的腦過度灌注綜合征課件

1、腦動脈支架治療相關(guān)的腦過度灌注綜合征廣東省人民醫(yī)院神經(jīng)科王 碩腦過度灌注綜合癥 (Cerebral Hyperperfusion Syndrome, CHS）1981年 sundt等 頸動脈內(nèi)膜切除術(shù) 顱內(nèi)動靜脈畸形切除術(shù)由于原先低灌注區(qū)腦血流量顯著增加超過腦組織代謝需要而引起的一種嚴(yán)重并發(fā)癥治療后5-7天隨著頸動脈成形和支架植入術(shù)的廣泛開展, 相關(guān)的病例報(bào)道逐漸增多, 術(shù)后的發(fā)生率在 1.1%-6.8%之間Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid end

2、arterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg. 2007 Dec;107(6):1130-6. Department of Neurosurgery, Iwate Medical University, Morioka, Japan. Retrospective study for hyperperfusion syndrome in 4494(CEA1596,CAS2898)Rate of hyperperfusion:1.4% including hem

3、orrhage(0.6%)Peak of hyperperfusion: CEA 6th day, CAS within 12hrsRate of hyperperfusion:CEA1.9%,CAS1.1%Rate of hemorrhage associated with hyperperfusion:CEA0.4%,CAS0.7%Pattern of hemorrhage: CEA ICH, CAS ICH+-SAHPoor prognosis in cases associated with hemorrhage男性， 56 歲診斷：右側(cè)腦梗塞 雙側(cè)頸內(nèi)動脈狹窄 高血壓病3級、極高危右

4、頸內(nèi)動脈重度狹窄術(shù)后2小時(shí)頭顱CT男，47歲 高血壓、冠心病、陳舊性心肌梗死（2002年）及高血脂 診斷：短暫性腦缺血發(fā)作 左側(cè)大腦中動脈重度狹窄 高血壓病2級（極高危） 冠心病 陳舊性心肌梗死Axial T2 gradient-echo MRI 24 hours after the procedure shows bilateral thalamic hemorrhageAxial flair MRI shows no lesions in both thalamiHemorrhagic complications after PTA/stenting for intracranial ar

5、terial stenosis3/130 cases (2.3%)caused HemorrhageICH:2,SAH:1Hemorrhage apperede winthin 24 hoursAll case showed stage on SPECT2 cases (1.5%)recognized hyperperfusion syndromeJapan.臨床癥狀頭痛（額顳）、面部和眼部疼痛惡心、嘔吐癲癇發(fā)作局灶性癥狀（腦水腫、腦出血）精神癥狀？發(fā)生機(jī)理慢性、長期-低灌注顱內(nèi)血管極度擴(kuò)張自動調(diào)節(jié)機(jī)制受損血流動力學(xué)儲備受損 Hyperacute Intracerebral Hemorrhage Complicating Carotid Stenting Should Be Distinguished from Hyperperfusion SyndromeAJNR Am J Neuroradiol 27:1508 13 Aug 2006primary ICH ?預(yù)示CHS因素長期持續(xù)的高血壓高度狹窄病變側(cè)支循環(huán)代償不良血管反應(yīng)性-乙酰唑胺CBF評估高灌注的預(yù)測與評估CBF檢測：SPECT、PET、Xe-CT、Perfusion-CTTCD預(yù) 防術(shù)后立即中和肝素嚴(yán)格控制血壓明確CHS狀態(tài)：TCD、灌注CT、SPECT依達(dá)拉奉？鈣離子拮抗劑？治 療控制血壓抗凝和抗血小板治療的控制依