颅内外动脉狭窄的介入治疗.ppt
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1、颅内外动脉狭窄的介入治疗 实施与培训的体会,刘新峰 南京军区南京总医院神经科 南京大学神经病学研究所 http:/www.chinaneurology.org,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. Hippocrates (460-370 BC) 希波克拉底(约公元前460-370, 称医药之父),M
2、edicaments for Stroke,Anti-platelet agents (proved by EBM) Thrombolysis (proved by EBM) Anti-coagulation (limited efficacy) Neuroprotection (not proved by EBM) Herb medicine (not proved by EBM),Knives for Stroke treatment,Decompressive craniotomy (unacceptable complications) Carotid endarterectomy (
3、limited indications) EC/IC bypass surgery (it works, but does not help) Clamp the aneurysm (limited to SAH),Do we have a searing iron ? Stent,Why should Neurologists be trained with endovascular techniques?,The future of neurology will be focused in treatment Lessens learned from cardiology Endovasc
4、ular techniques will become key issue in stroke treatment and prevention The special status of stroke management in China,血管神经病学:神经科新分支,How to train a Neuro-endovascular specialists (recommendations from academic societies),The American Neurosurgery Association (ANA) When to do it The American Heart
5、 Association (AHA) How long to do it The American Academy of Neurology (AAN) How to insure maintenance of skills and knowledge The American Association of Cycle of Science in Medicine How to up-date,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
6、介入的培训,2 years of clinical work in stroke management with experience of diagnostic imaging 1 years of training on neuro-endovascular skills, at least finish 80 case of DSA before stenting 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 training,Procedure training pre-procedure evaluation Indication and co
7、ntraindication risk reducing management of complications post-procedure management follow-up,Contents of training,Endovascular skill training Acupuncture Cerebrovascular angiography Carotid angioplasty (balloon dilation) Carotid stent implantation Angioplasty and stenting in veterbrobasilar arteries
8、,Pre-procedure Evaluations,Auscultation & Stethoscope Carotid duplex ultrasonography Transcranial Doppler Computed tomographic angiography (64-tier-CTA) Magnetic resonance angiography (MRA) Carotid angiography (the gold standard),颈动脉支架术的适应症,American Heart Association Guidelines Asymptomatic Patients
9、 For treatment of 70% or greater stenosis Perioperative stroke/death must be less than 3% Symptomatic Patients For treatment of 50% or greater stenosis Perioperative stroke/death must be less than 6% No proven indications beyond these thresholds,颅内动脉狭窄支架术的建议适应症,症状性颅内动脉狭窄50%病例,通过药物治疗无效,应考虑行球囊血管成形术,同时
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- 关 键 词:
- 内外 动脉 狭窄 介入 治疗
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