远端保护装置下颈动脉支架术预防卒中的安全性和有效性研究

Safety and efficacy on cerebral protection with filter devices during carotid artery stenting in Chinese patients

目的探讨在远端保护装置下行颈动脉支架术对预防缺血性脑卒中的安全性、可行性以及中、远期临床效果。方法对2002—2005年住院的58例颈动脉狭窄超过70%的患者,在置入远端保护伞装置后行颈动脉支架置入术,术后行心脑血管专科及颈动脉超声检查随访。结果 58例患者中57例成功置入远端保护伞装置,远端保护伞装置置人的成功率为98%;59处颈动脉狭窄病变共置入61枚支架,支架置入成功率100%。平均颈动脉狭窄程度由术前的(81.3±19.6)%减少到术后的(6.2±1.3)%。颈动脉狭窄处直径由术前(1.3±0.9)mm 增加到(5.2±1.1)mm;平均住院2.5天;1例患者术中发生小卒中。平均随访时间(14±2)个月,随访期间,2例患者发生无症状性颈动脉狭窄;2例发生心肌梗死;1例发生小卒中;无大卒中及无死亡发生。结论远端保护伞装置置入及在其下进行的经皮颈动脉支架术成功率高、安全性好,能够有效减少近、远期卒中的发生。

Objective To assess the efllcecy, safety, procedural success and long-term clinical outcome in patients underwent percutaneeus carotid stenting with distal device. Methods Percutaneous carotid stents with distal device were implanted to 58 patients with 59 significant （ 〉 75% ） carotid artery stenosis （49 men, mean age 68 years） between January 2000 to December 2005. Fourty-five out of 58 patients were symptomatic, 35 had coronary artery diseases and 10 had previous strokes. Results Sixty one carotid stenting were implanted to 59 lesions in 58 patients. Stents with filter devices were successfully implanted in 57 out of 58 （98%） patients. Angioplasty success rate was 100%. Aspirin （300 mg/d） and Clopidogrel （75 mg× 2/d） were administered 3 days prior operation and clopidogrel was discontinued 30 days post stenting and aspirin was continued at dose of 100 mg/d. The percentage of stenotic carotid artery reduced from 85.3% to 6. 2% after stenting and the diameter increased from 1.3 ± 0. 9 mm to 5.2 ± 1.1 mm. Two minor strokes （3.4%） occurred during operation and at 14 days post stenting. All patients were discharged from the hospital after an average of 2. 5 days hospilization. At 14 ± 2 months follow up, all patients survived and there were 2 asymptomatic restenosis （50% and 70% and the latter underwent successful balloon angioplasty ）, 2 myocardial infarctions （1 non-Q wave and 1 Q wave myocardial infarction, all underwent successful emergent PCI） and 2 minor strokes occurred at 6 and 8 months post stenting. Conclusion Carotid stenting with distal device appears to be safe and effective in treating patients with carotid artery stenosis.