颅内外动脉狭窄的介入治疗课件.pptx

1、Anti-coagulation(limited efficacy)L-MCA-M2 stenting:Chen BY-F-75yAngioplasty and stenting in veterbrobasilar arteries病人选择、标准化术前评诂、术中操作规程和标准化的术后跟踪随访Computed tomographic angiographyThis helps to avoid micro-bubblesCarotid endarterectomy(limited indications)Wingspan支架后(3.Type and size of stent should b

2、e chose with reference to artery pathology and anatomy characters.有必要继续评价和改进药物及介入治疗，以降低颅内动脉粥样硬化相关的卒中Asymptomatic Patientspre-procedure evaluationICA起始部狭窄合并同侧颅内动脉瘤Wingspan颅内专用支架:Mao YQ-M-73yArterial access issues监测有无新的神经病学症状，间隔6-12月定期行无创性影像学检查（磁共振血管成像或CT血管成像），有必要的话再进行脑血管造影检查,对于进展的患者再评诂介入治疗的可行性No majo

3、r co-morbidityAortic arch and carotid anatomy and pathologyArterial TortuosityContents of training Arterial TortuosityEccentric calcification with ulcerationCarotid duplex ultrasonographyLearning curve 80 casesProviding Information for Collateral CirculationAngioplasty and stenting in veterbrobasila

4、r arteriesAngioplasty and stenting in veterbrobasilar arteriesWingspan支架后(3.Why should Neurologists be trained with endovascular techniques?with experience of diagnostic imagingWhat cannot be cured with medicaments is cured by knife,what knife cannot cure is cured with searing iron,and whatever this

5、 cannot cure must be considered incurable.Carotid endarterectomy(limited indications)No major co-morbidity监测有无新的神经病学症状，间隔6-12月定期行无创性影像学检查（磁共振血管成像或CT血管成像），有必要的话再进行脑血管造影检查,对于进展的患者再评诂介入治疗的可行性Type and size of stent should be chose with reference to artery pathology and anatomy characters.No proven indic

6、ations beyond these thresholdsAsymptomatic PatientsWhat cannot be cured with medicaments is cured by knife,what knife cannot cure is cured with searing iron,and whatever this cannot cure must be considered incurable.Medical comorbiditiesThe American Heart Association(AHA)Collateral Circulationwith e

7、xperience of diagnostic imagingWingspan支架后(3.filterPre-BostentPost-BocontrastL-MCA-M2 stenting:Chen BY-F-75y病人选择、标准化术前评诂、术中操作规程和标准化的术后跟踪随访Contents of trainingArterial TortuosityPatient Selection颅内动脉狭窄支架术的建议适应症Longer balloons may cause dissections in the distal internal carotid artery.Transcranial Do

8、pplerDo we have a searing iron?StentWhat cannot be cured with medicaments is cured by knife,what knife cannot cure is cured with searing iron,and whatever this cannot cure must be considered incurable.Clamp the aneurysm(limited to SAH)Collateral Circulation双支架置入覆盖夹层动脉瘤:张荣X-M-62y,脑梗塞,RICA-C1,C2段有两处狭窄

9、，近段夹层动脉瘤形成至C1近端80%狭窄,LICA起始部狭窄30%Angioplasty and stenting in veterbrobasilar arteriesDecompressive craniotomy(unacceptable complications)with experience of diagnostic imagingHow long to do itAsymptomatic PatientsIndication and contraindicationIndication and contraindication症状性颅内动脉狭窄50%病例，通过药物治疗无效，应考

10、虑行球囊血管成形术，同时实施或不实施支架置入术Eccentric calcification with ulcerationArterial Tortuosity2 years of clinical work in stroke managementContents of trainingDo we have a searing iron?StentAsymptomatic PatientsTranscranial DopplerL-MCA-M2 stenting:Chen BY-F-75yballooning;PCA stentingDifficult aortic archDo not

11、flush cerebral catheters with too much volumeMedicaments for StrokeIts not as easy as it lookspre-procedure evaluationIf continued flow of contrast into an ulcer is seen,no attempt should be made to obliterate it by using larger balloons or higher pressure.Asymptomatic PatientsLonger balloons may ca

12、use dissections in the distal internal carotid artery.Computed tomographic angiographyThe special status of stroke management in ChinaWingspan支架后(3.Gateway(2.5/9mm)预扩 Wingspan支架后(3.5/9mm)RICA-C6段85%狭窄R-ICA-C7段70%狭窄Gateway球囊(2.5/9mm)预扩 Wingspan支架后(3.5/15mm)Wingspan for MCA-M2欢迎参会欢迎参会!谢谢参与谢谢参与!Wingspa

13、n支架后(3.Clamp the aneurysm(limited to SAH)Wingspan颅内专用支架:Mao YQ-M-73yEndovascular skill trainingNeuroprotection(not proved by EBM)The balloon should be inflated only once and the inflation time varies depending on the lesion.Clamp the aneurysm(limited to SAH)How to up-dateRICA-C6段85%狭窄Angioplasty and

14、 stenting in veterbrobasilar arteriesContents of trainingAnti-platelet agents(proved by EBM)Contents of trainingPCA stentingR=retrieving of filter.Herb medicine(not proved by EBM)Difficult aortic archAmerican Heart Association GuidelinesLonger(but slender)balloons are used to avoid“melon seeding”and

15、 the potential release of embolic debris.How to train a Neuro-endovascular specialists(our experiences at Jinling Hospital)南京军区总医院神经内科如何进行神经介入的培训Shorter balloons are used for postdilation.有必要继续评价和改进药物及介入治疗，以降低颅内动脉粥样硬化相关的卒中 Arterial Tortuosity颅内动脉狭窄支架术的建议适应症L-MCA-M2 stenting:Chen BY-F-75yCarotid enda

16、rterectomy(limited indications)EC/IC bypass surgery(it works,but does not help)Cs=ContrastWhen to do itMultiple kinks may be displaced distally and become more exaggerated.Type and size of stent should be chose with reference to artery pathology and anatomy characters.Neuroprotection(not proved by E

17、BM)Start with easy casesWingspan支架后(3.Clamp the aneurysm(limited to SAH)Contents of trainingPCA stentingPCA stenting双支架置入覆盖夹层动脉瘤:张荣X-M-62y,脑梗塞,RICA-C1,C2段有两处狭窄，近段夹层动脉瘤形成至C1近端80%狭窄,LICA起始部狭窄30%What cannot be cured with medicaments is cured by knife,what knife cannot cure is cured with searing iron,and whatever this cannot cure must be considered incurable.欢迎参会!谢谢参与!监测有无新的神经病学症状，间隔6-12月定期行无创性影像学检查（磁共振血管成像或CT血管成像），有必要的话再进行脑血管造影检查,对于进展的患者再评诂介入治疗的可行性2 years of clinical work in stroke managementLessens learned from cardiology