多模式影像指导下支架成形术治疗颅外颈动脉狭窄的研究

摘要

目的 评估多模式影像指导下支架成形术治疗颅外颈动脉狭窄的可行性和安全性.方法 从2010年1月至2013年12月,入选颅外颈动脉狭窄患者100例,随机分为常规颈动脉狭窄支架成形成术组(常规CAS组)和多模式影像指导下颈动脉狭窄支架成形成术组(个体化CAS组),各50例,完整地评估神经专科的情况,常规CAS组和个体化CAS组年龄、性别差异无统计学意义.结果 常规CAS组和个体化CAS组技术成功率均为100％.围手术期总并发症:l4.0％和12.0％,差异无统计学意义(P＞0.05),神经系统并发症:6.0％和4.0％,差异无统计学意义(P＞0.05).随访6个月,常规CAS组和个体化CAS组脑血管事件发生率分别为:12.0％和8.0％,差异无统计学意义(P＞0.05),血管再狭窄率分别为:24.0％和6.0％,差异有统计学意义(P＜0.05).结论 多模式影像指导颅外颈动脉狭窄支架成形术能降低远期血管再狭窄率,但尚未能降低远期脑血管事件发生率,支架成形术是治疗颅外颈动脉狭窄的可行和安全方法之一.%Objective To assess the feasibility and safety of stenting of extracranial carotid stenosis by multimode image.Methods 100 cases of extracranial carotid stenosis from January 2010 to December 2013 were randomly divided into routine CAS group (routine stenting of extracranial carotid stenosis) and individual CAS group (stenting of extracranial carotid stenosis by multimode image),50 cases in each group.Patients' neurological conditions were completely assessed.There were no statistically significant differences in age and gender between two groups.Results The technical success rate was 100％ in both two groups.The rate of perioperative complications was 14.0％ in routine CAS group,and 12.0％ in individual CAS group,without statistically significant difference between two groups (P ＞ 0.05).The rate of nervous system complications in routine CAS group was 6.0％,and 4.0％ in individual CAS group,without statistically significant difference between two groups (P ＞ 0.05).After 6 months of follow up,the rate of cerebrovascular events in routine CAS group was 12.0％,and 8.0％ in individual CAS group,without statistically significant difference between two groups (P ＞ 0.05); the rate of vascular restenosis in routine CAS group was 24.0％,and 6.0％ in individual CAS group,with statistically significant difference (P ＜ 0.05).Conclusions Stenting of extracranial carotid stenosis by multimode image can decrease the rate of long-term vascular restenosis,but fails to decrease the rate of long-term cerebrovascular disease.Stenting is one of feasible and safe methods in the treatment of extracranial carotid stenosis.