目的：探讨单侧与双侧颈动脉狭窄患者支架植入术的疗效及其影响因素。方法回顾性研究2005年1月至2011年1月第三军医大学附属新桥医院收治的312例颈动脉狭窄支架植入术患者临床资料。依据患者颈内动脉病变情况，分为单侧颈动脉狭窄组和双侧颈动脉狭窄组，分别收集两组患者术前、术中、术后1个月及术后1年的数据并进行统计学分析。结果共312例患者纳入本研究，其中双侧病变组136例，单侧病变组176例。完成术后1个月随访的患者303例，完成术后1年随访的患者224例。312例患者共植入391枚支架。两组患者围术期短暂性脑缺血发作（ TIA）的发病率差异有统计学意义（双侧病变组7．6％和单侧病变组1．2％；P＜0．01）。单侧病变组术后早期不良事件（死亡、卒中、围术期TIA、围术期心肌梗死）发生率较双侧病变组低（5．2％/11．4％），但两组间差异无统计学意义（P＞0．05）。双侧病变组中期不良事件（死亡、卒中、围术期TIA、围术期心肌梗死、再狭窄）发生率较单侧病变组显著升高（21．8％/9．7％，P＜0．01），其中死亡、围术期TIA、再狭窄的发病率较高（P＜0．05）。多因素分析显示，左心功能不全颈动脉支架植入术（ CAS）后发生血管再狭窄、男性、双侧颈动脉病变、肾功能不全、支架植入术前6个月内脑缺血症状以及低密度脂蛋白胆固醇（ LDL-C）水平是中期不良事件发生的独立危险因素。结论 CAS术后，双侧病变组较单侧病变组出现不良事件的风险更高。%Objective To investigate the efficacy and risk factors of carotid artery stenting ( CAS) in patients with uni-lateral and bilateral carotid stenosis .Methods We retrospectively studied 312 cases of patients with CAS diagnosed in xinqiao Hospital between January 2005 and January 2011 .According to the carotid artery lesions , patients were divided in-to the unilateral carotid stenosis group .Periprocedural data and those after one-month follow-up and one-year follow-up were collected in two groups and analysed by statistics .Results A total of 312 patients were enrolled in this study , including 136 patients with bilateral lesions and 176 patients with unilateral lesion .303 of these patients were followed up after one month, and 224 cases after one year.All the 312 patients were implanted with 391 stents.The two groups of patients with transient ischemic attack ( TIA) were different in the incidence of perioperative TIA (1.2%for bilateral lesions and 7.6%for unilateral lesions;P<0.01).Compared with bilateral carotid lesions group , the incidence of early postoperative adverse events (death, stroke, perioperative TIA,and perioperative myocardial infarction ) in unilateral carotid lesion group was lower (5.2%vs 11.4%), but of no statistical significance (P>0.05).The incidence of medium-term adverse events (death, stroke, perioperative TIA, perioperative myocardial infarction, and restenosis) in the bilateral carotid lesions group was significantly higher than in the unilateral group (21.8%vs 9.7%, P<0.01), mainly driven by a higher inci-dence of death, periprocedural TIA, and restenosis (P<0.05).Multivariate analysis showed that left ventricular dysfunc-tion, masculinity , bilateral carotid artery disease , renal insufficiency , and cerebral ischemic symptoms within the last 6 months before intervention , and low-density lipoprotein cholesterol ( LDL-C ) levels were the independent risk factors for medium-term adverse events .Conclusion Patients with bilateral carotid artery disease treated by CAS are more prone to adverse events than those with unilateral disease .
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