摘要
目的探讨颈动脉支架置入术与颈动脉内膜切除术治疗颈动脉狭窄的近期疗效及安全性。方法195例症状性颈动脉狭窄（i〉60％）患者，随机分为颈动脉内膜切除术组（CEA组，97例），颈动脉支架组（CAS组，98例）。CEA组在全麻下行颈动脉内膜切除术，CAS组采用自膨式镍钛合金支架治疗。分别评价两组术中、术后7d、30d和90d内终点事件发生率（卒中／死亡）及治疗相关的并发症，术中、术后7d、术后30d及90d行颈动脉超声，头颅CT／MRI、NIHSS评分。结果CAS组术后7d内死亡1例，卒中2例，发生率3．1％。CEA组术后7d死亡1例，2例卒中，发生率为3．1％，两组差异无统计学意义（P〉0．05）。术中及术后7dCEA组术后并发脑神经损伤较CAS组高（P〈0．05），卒中／死亡、急性颈动脉闭塞、高灌注综合征、局部血肿形成，两组差异无统计学意义（P〉0．05）。CAS组与CEA组神经功能缺失表现均明显改善，两组差异无统计学意义（P〉0．05）。术后7d、30d、90d两组头颅CT／MRI差异无统计学意义（P〉0．05）。结论CAS及CEA在治疗症状性颈动脉狭窄，预防卒中复发方面具有相似的近期效果，但其远期效果有待于进一步研究。
Objective To compare stenting treatment with endarterectomy in patients with symptomatic carotid stenosis（at least 60% ）. Methods We conducted a center randomized controlled noninferiority trial for comparing stenting treatment to endarterectomy in 195 patients with severe symptomatic atherosclerotic carotid artery stenosis. The primary end point of this hospital - based study was ipsiateral ischaemic stroke or death from time of randomisaion to 90 days after the proceduce. The secondary end point was the related complications of either intervention, or severe restenosis at 90 day after operation. Results 195 patient were induded in the analysis. The rate of death or ipsiateral ischaemic stroke frow randomization to 90 days after stenting procedure was 3. 1% and 3. 1% after carotid endarterectomy. The one - sided p value for non - inferiority is 0.08. The secondary end point occurred in 8 patients randomly assigned to undergo endarterectomy （cumulative incidence, 8. 3% ） and 5 patients randomly assigned to undergo stenting （cumtdative in cadence, 5. 1% ）. The difference was not significant. Cranial - nerve injury was more commonly seen after endarterectomy than that after stenting. Conclusions There is no difference in the risks of stenting treatment compared with carotid endarterectomy. The risk of stroke or death after 90 days of treatment is almost identical in both groups.
出处
《中华神经外科杂志》
CSCD
北大核心
2012年第4期382-385,共4页
Chinese Journal of Neurosurgery
