不同手术方式治疗高危颈动脉狭窄患者围手术期安全性的回顾分析

A review for safety of different surgical therapy in patients with high-risk carotid artery stenosis

目的:探讨合并高危因素的颈动脉狭窄病变的手术方法。方法:对2011年1月至2016年 12月,北京安贞医院血管外科收治的高危颈动脉狭窄共439例临床资料进行回顾性分析。其中214例实施了颈动脉支架置入术(CAS),225例实施了颈动脉内膜剥脱术(CEA)。对比分析两组组间临床特征、危险因素、围手术期30 d内的严重心脑血管不良事件及死亡的累计发生率。结果:CAS组围手术期严重并发症累计发生率10. 3%(22/214例);CEA组围手术期严重并发症累计发生率9. 8%(22/225例)。两组患者严重并发症累计发生率比较,差异无统计学意义(P<0. 05)。结论:对于高危颈动脉狭窄患者,CAS和 CEA均具有较高的安全性,前提是术前应全面评价患者的基础情况,选择适当的手术方式。

Objetive :To investigate the surgical therapy of carotid stenosis with high-risk actors. Meth-ods: Between January 2011 to December 2016 in Beijing Anzhen Hospital,CEA or CAS were performed in 439 patients with high-risk carotid artery stenosis,the perioperative outcomes were analyzed.The complications in-cluded stroke, hematencephalon, myocardial infarction, and death within 30 days. Results: In CAS Group, the serious perioperative cumulative complication rates were 10. 3%(22/214).In CEA group,the serious periopera-tive cumulative complication rates were 9. 8%( 22/225 ).The complication rates have no significant difference between the two groups. Conclusions : For patients with high-risk carotid stenosis, both CAS and CEA are safe-ty, provided that the patient's basic condition should be fully evaluated before surgery and appropriate surgical method should be selected.