作者介绍：作者之一焦德让主任医师为武警医学院附属医院脑系科(医院)中心名誉院长，对颅内动脉瘤的血管内、外的治疗以及动脉瘤破裂急症期的处理及栓塞治疗做了大量的临床工作。近年来承担国家科委“九五”攻关课题，“出血性和缺血性脑血管病手术新方法应用研究”曾获部级科技进步三等奖；“硬脑膜动静脉瘘动物模型建立、发病机理及临床诊治研究” 获解放军总后勤部科技进步二等奖；在此学术范畴曾发表学术论文40余篇。

偏倚或不足：本组样本量不足，为非随机试验，对结果仅为简单统计学观察。今后如能做到病例配对或分层分析结果会更有意义。

临床应用性：实验结果表明，目前使用的脑保护装置不能减少颈动脉狭窄患者支架置入过程中的神经并发症。希望应用新一代的脑保护装置能减少支架置入的神经并发症，而支架置入应是治疗颈动脉狭窄的外科手术的有效替代疗法之一。

摘要
背景：对于脑保护装置在颈内动脉支架置入过程中是否有助于减少神经并发症还没有定论。
目的：观察颈动脉狭窄行颈动脉血管成形和支架置入过程中应用脑保护装置减少神经并发症发生的有效性。
设计、时间及地点：非随机同期对照分析，2005-06/2007-01在武警医学院附属医院进行。
对象：应用支架置入治疗颈动脉狭窄患者74例，应用脑保护装置组21例，男16例，女5例；年龄50~79岁，平均66.4岁。未应用脑保护装置组53例，男36例，女17例；年龄52~83岁，平均69.2岁。
方法：根据颈动脉狭窄远端正常血管的直径选择脑保护装置的大小。在路径图下将导丝送至狭窄远端，释放脑保护装置。在微导丝引导下将支架跨过狭窄部位，在透视下将支架释放于合适位置。常规造影证实狭窄解除后回收脑保护装置。
主要观察指标：①支架置入操作特点。②围手术期与随访12个月时两组患者发生脑卒中的频数。
结果：①74例颈动脉狭窄患者成功释放76枚支架。共使用脑保护装置 21枚，其中Angioguard 8枚，Filterwire13枚。未使用脑保护装置组球囊预扩20次(37.7%)，均后扩；3例(5.6%)在支架释放后出现短暂性心率减慢和低血压。使用脑保护装置组球囊预扩6次(28.5%)，均后扩。2例(9.5%)在支架释放后出现短暂性心率减慢和低血压，2例（9.5%）血管痉挛。②使用脑保护装置组在围手术期1例（4.7%）发生脑梗死；随访期1例（4.7%）发生脑梗死，未使用脑保护装置组围手术期发生4例(7.5%)脑梗死，随访期发生5例(9.4%)脑梗死。两组比较差异无显著性意义。
结论：本组病例统计结果显示，脑保护装置的应用未减少颈动脉狭窄患者支架置入治疗后神经并发症的发生。
关键词：脑保护装置；颈动脉狭窄；血管成形和支架置入

薛德友，焦德让,常斌鸽.脑保护装置在颈动脉支架置入过程中的有效性[J].中国组织工程研究与临床康复，2008，12(22):4217-4220 [www.zglckf.com/zglckf/ejournal/upfiles/08-22/22k-4217(ps).pdf]

Efficacy of cerebral protection devices during carotid artery stenting

Abstract
BACKGROUND: There is yet no evidence about whether internal carotid artery stenting with cerebral protection devices is beneficial to reducing neurological complications.
OBJECTIVE: To explore the safety and efficacy of carotid angioplasty and stenting with cerebral protection devices for carotid stenosis.
DESIGN, TIME AND SETTING: Non-randomized concurrent control trial was performed at Hospital Affiliated to Medical College of Chinese People's Armed Police Force from June 2005 to January 2007.
PARTICIPANTS: Seventy-four patients with carotid artery stenosis underwent stenting, including 21 with cerebral protection devices (16 males and 5 females; average age of 66.4 years, range 50-79 years), and 53 with no protection devices (36 males and 17 females; average age of 69.2 years, range 52-83 years).
METHODS: Size of cerebral protection devices was confirmed according to the diameter of normal vessel at distal carotid artery stenosis. The guide wire was sent into distal stenosis under guidance of pathway picture followed by cerebral protection device release. The stent passed over the stenosis and released to appropriate site. The protection device was removed when the stenosis was relieved confirmed by routine angiography.
MAIN OUTCOME MEASURES: Features of stenting process; frequency of stroke attack perioperatively and during 12-month follow-up. All of them took periprocedual anticoagulation treatment, cerebral vascular angiograpgy.
RESULTS: Seventy-six self-expandable stents were delivered in 74 patients with carotid stenosis. Twenty-one cerebral protection devices were employed including 8 Angioguard and 13 Filterwire. The patients without cerebral protection devices were predilated 20 times (37.7%) with the balloons, and all were postdilated; 3 cases (5.6%) developed brief decreased heart rate and hypotension after stent release. The patients with cerebral protection devices were predilated 6 times (28.5%) with balloons, and all were postdilated; 2 cased (9.5%) developed brief decreased heart rate and hypotension after stent release and 2 (9.5%) developed angiospasm. One patient (4.7%) with cerebral protection devices had cerebral infarction (4.7%) perioperatively and another had cerebral infarction (4.7%) during the follow up. While four patients in the group without cerebral protection devices had cerebral infarction (7.5%) perioperatively, and five had cerebral infarction (9.4%) during the follow up. There were no significant differences between two groups.
CONCLUSION: The results of the study show that cerebral protection devices are not helpful to reduce neurological complications in patients with carotid artery stenosis after stenting.

Xue DY, Jiao DR, Chang BG.Efficacy of cerebral protection devices during carotid artery stenting. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(22):4217-4220(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-22/22k-4217(ps).pdf]