颈动脉狭窄血管内支架植入和内膜切除术治疗的临床选择

摘要

目的 探讨在不同条件下如何合理选择颈动脉狭窄的治疗方式.方法 回顾性分析经颈动脉血管内支架植入术(CAS)和颈动脉内膜切除术(CEA)治疗的133例颈动脉狭窄患者的临床资料.其中46例患者行CAS,87例行CEA.观察两组患者的住院天数和治疗前后的美国国立卫生研究院卒中评分量表(NIHSS)评分、前向血流,治疗前和治疗后1-24个月狭窄处收缩期血流速度峰值及狭窄程度,以及治疗后死亡、脑卒中或心肌梗死等终点事件的发生率.结果 两组住院天数和治疗后NIHSS评分>20层次时差异有统计学意义(P<0.05);两组治疗前后的前向血流评定差异无统计学意义(P>0.05);多普勒频谱测定两组治疗前后颈动脉狭窄程度有显著性差异(P<0.05);两组治疗后30 d内,终点事件的累计发生率差异有统计学意义(P<0.05);31 d～2年终点事件的累计发生率差异无统计学意义(P>0.05);6个月后再狭窄发生率CAS组高于CEA组.结论 CAS和CEA对颈动脉狭窄的效果无显著差异,狭窄的部位、原因及对侧病变是选择CAS和CEA的重要因素.%Objective To explore reasonable clinical decision in treating carotid artery stenosis under difierent conditions.Methods The data of 133 carotid artery stenosis patients were retrospectively analyzed.Of the patients.46 cases were treated with carotid angioplasty and stenting(CAS),87 patients received carotid endarterectomy(CEA).The length of hospital stay and National Institutes of Health Stroke Scale(NIHSS)grade before and after treatment in both groups were observed;the forward flow were assessed by digital subtraction angiography(DSA)before and after treatment;the degree of carotid artery stenosis were determined by using ultrasound during 3 to 24 months after treatment in both groups;the cumulative incidence of major cardiovascular events was concentrated,including appearance of death,stroke or myocardial infarction during 30 days after CAS and CEA and death or homonymy stroke during 31 days to 2 years.Results Significant difierence was found in hospital stay and when NIHSS exceed 20 after treatment between the two groups(P<0.05);there was no significant difference in the forward flow beforeand after treatment in both groups:the carotid artery stenosis had been improved significantly after the operation in both groups;the cumulative incidence of major eardiovascular events in CEA group was significandy higher than in CAS group in 30 days after the operation(P<0.05),but no statistical difference in 31 days to 2 years after the operation.Conclusions CAS and CEA has equivalent effects in treating carotid artery stenosis,and should be selected according to the location of stenosis,etiological factors and the condition of opposite carotid artery.