冠状动脉旁路移植术前支架置入术治疗颈动脉狭窄——中期随访结果

Mid term Outcome of Carotid Artery Stenting Before Coronary Artery Bypass Graft Surgery

目的评价冠状动脉旁路移植术前支架置入术治疗颈动脉狭窄的安全性和有效性。资料与方法对8例严重冠心病合并颈动脉狭窄患者于冠状动脉旁路移植术前行颈动脉支架置入术。8例冠状动脉造影均示3支血管病变，其中3例合并左主干病变；颈动脉造影示颈内动脉狭窄，有症状者狭窄≥50％，无症状者狭窄≥70％。结果技术成功率100％。共置入8枚自膨胀式支架。8例均于支架置入术后1～14天（平均6．0天）行冠状动脉旁路移植术，1例同时行主动脉瓣置换术。手术恢复顺利，无脑卒中、过度灌注综合征或死亡等严重并发症。随访11～41个月，平均28．4个月，1例复查造影示支架内再狭窄。结论冠状动脉旁路移植术前在适当内科治疗基础上实施支架置入术治疗伴发的颈动脉狭窄是安全、有效的，中期疗效满意。

Objective To evaluate the safety and efficacy of carotid artery stenting （CAS） before coronary artery bypass graft （CABG）surgery. Materials and Methods From February 2002 to August 2004, CAS was performed in 8 patients with severe coronary artery disease who were candidates for selective CABG surgery. The patients, including 6 males and 2 females, were aged 50 to 71 years （mean age 65.3 years）. The inclusion criteria were：（ 1 ）triple-vessel disease with or without left main artery disease proven by coronary artery angiography, （2）inner carotid arterial stenose greater than 50% in symptomatic patients or greater than 70% in asymptomafic ones, （3）no stroke or neurological unstabilization in recent three weeks. All the lesions were located in the proximity of inner carotid artery. Three patients had bilateral stenosis, 2 of them had total occlusions in the right inner carotid artery. CAS was performed 1 to 14 days before CABG surgery. Results The technical success rate was 100% . Five Wallstent and 3 Memotherm stents were implanted in the stenotic inner carotid artery. The average diameter of the stents was 8.4 mm （range from 6 - 9 mm） and the average length was 25.8 mm （range from 20 - 30 mm）. During CAS, one patient developed bradycardia which was treated with atropine successfully. There was no stroke, over-perfusion syndrome or death in this group. All the patients received a mean 28.4 months follow-up （range from 11 to 41 months）. Excellent mid-term outcome was found except for one case that developed in stent restenosis, Conclusion GAS is safe and effective for concomitant inner carotid artery stenosis before CABG surgery. The mid term outcome is satisfactory.