实时动脉测压装置在脑动脉支架植入术中的应用OACSTPCD

Objective To evaluate the changes of proximal arterial pressure and peripheral blood pressure in patients with symptomatic cerebral artery stenosis before and after cerebral artery stenting,and to evaluate the safety and efficacy of real-time arterial pressure measurement device.Methods Fifty patients with carotid artery stenosis and 50 patients with vertebral artery stenosis diagnosed by digital subtraction angiography were selected.During the treatment of cerebral vascular stent implantation,the guiding catheter was sent to the proximal stenosis of the treated vessel,the real-time arterial pressure measuring device was connected to measure the arterial pressure,and the average peripheral blood pressure of the corresponding upper limb was measured at the same time.The proximal mean arterial blood pressure and upper limb mean peripheral blood pressure were recorded after stent angioplasty in the same way,and the mean pressure difference of proximal stenosis was compared before and after stent angioplasty,and the influencing factors were evaluated,as well as the safety and effectiveness of arterial pressure measurement device.Results The acquisition rate of proximal pressure difference before and after operation was 100%in 100 patients with cerebral artery stenosis,the difference of proximal pressure difference before and after operation was statistically significant(P<0.001).In the same group,the mean arterial pressure of patients with moderate and severe stenosis was significantly higher than that of patients with moderate stenosis before treatment(P<0.05);in the vertebral artery group,only the mean peripheral blood pressure of patients with severe stenosis after stenting was significantly lower than that before stenting(P<0.05).The difference of arterial pressure in the carotid artery group was significantly higher than that in the vertebral artery group(P<0.05).For patients with carotid artery stenosis undergoing stent implantation,the mean arterial pressure difference was(18.03±17.28)mmHg(1 mmHg=0.133 kPa)before and after operation,and there was no significant correlation between the change of pressure difference and peripheral blood pressure(r=0.448,P>0.05),but there was a positive correlation between the change of pressure difference and the degree of stenosis(r=0.827,P<0.001).For patients with vertebral artery stenosis undergoing stent implantation,the mean arterial pressure difference before and after operation was(10.25±16.75)mmHg,which was positively correlated with peripheral blood pressure(r=0.664,P<0.05)and the degree of stenosis(r=0.843,P<0.005).The correlation analysis of preoperative and postoperative arterial pressure difference in all patients also showed that the degree of stenosis was positively correlated with the preoperative and postoperative arterial pressure difference of the proximal stenosis(r=0.693,P<0.005).There was no plaque shedding during the monitoring process with the arterial pressure measurement device,and there were no complications such as vascular dissection and embolic bleeding.Conclusion Real-time arterial pressure monitoring device can safely and effectively monitor the changes of blood pressure during and after cerebral artery stenting,arterial stent implantation can effectively reduce the blood pressure of the proximal stenosis,which provides a reference for early prediction of the degree of vascular stenosis and blood pressure management during and after operation to formulate targeted clinical treatment.