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目的 探讨短暂性脑缺血发作 (TIA)患者的脑血管病变基础及治疗方法。方法 对 4 7例颈动脉系统TIA患者行全脑血管造影 ,了解血管病变的程度。 7例颈动脉狭窄 >70 %的患者行自膨式支架置入治疗 ,37例行选择性动脉溶栓治疗。结果 本组患者脑血管造影显示大脑半球供血减少 3例 ,大脑中动脉狭窄 2 2例 ,大脑前动脉狭窄 1例 ,大脑后动脉狭窄 1例 ,颈内动脉狭窄 10例 ,颈总动脉狭窄 4例 ,未见血管异常影像 6例。应用自膨式支架治疗颈总、颈内动脉狭窄 >70 %的患者 7例 8处病变 ,共置入自膨式支架 12枚 ,残余狭窄均 <30 % ,随访 6～ 2 3个月 ,无再狭窄发生 ;选择性动脉溶栓治疗 37例 ,溶栓后脑血流明显改善 3例 ,好转 2 8例 ,无明显改善 6例。37例溶栓治疗者中 3例再次出现TIA发作 ,溶栓后对侧陈旧梗死灶出血 1例 ,无死亡病例。随访 3个月～ 3年 ,未见治疗血管发生脑梗死者。结论 TIA患者多已存在血管器质性病变 ,应尽早行相应的有效治疗
Objective To investigate the basis and treatment of cerebrovascular disease in patients with transient ischemic attack (TIA). Methods Forty-seven patients with TIA in the carotid system underwent whole-cerebral angiography to understand the extent of vascular lesions. Seven patients with carotid stenosis> 70% underwent self-expanding stenting and 37 received selective arterial thrombolysis. Results Cerebral angiography in this group showed cerebral hemisphere reduced blood supply in 3 cases, cerebral artery stenosis in 22 cases, cerebral anterior cerebral artery stenosis in 1 case, cerebral artery stenosis in 1 case, internal carotid artery stenosis in 10 cases, carotid artery stenosis in 4 cases , No abnormal vascular images in 6 cases. Seven cases of 8 lesions were treated with self-expandable stent in 7 cases with total carotid and internal carotid artery stenosis. A total of 12 self-expandable stents were included. The residual stenosis was less than 30%, followed up for 6 to 23 months, without Restenosis occurred in 37 cases of selective arterial thrombolysis, thrombolytic cerebral blood flow improved significantly in 3 cases, improved in 28 cases, no significant improvement in 6 cases. Thirty-seven patients with thrombolytic therapy again experienced TIA in one of the three patients, and 1 died of contralateral infarction in the contralateral side after thrombolysis, with no deaths. Follow-up of 3 months to 3 years, no treatment of vascular infarction in patients with vascular. Conclusion TIA patients already have vascular organic disease, the corresponding effective treatment should be as soon as possible