老年人颈动脉狭窄支架置入术的血流动力学紊乱研究

Periprocedural hemodynamic instability for carotid angioplasty and stenting in elderly patients with carotid stenosis

目的探讨老年人颈动脉狭窄支架置入术血流动力学紊乱的发生、预防及处理方法。方法回顾性分析88例60岁以上颈动脉狭窄患者支架置入过程中发生的血流动力学紊乱病例,分析其临床和影像学特点。结果88例患者中血流动力学紊乱发生率为33%;70岁以上患者低血压和心动过缓发生率明显高于70岁以下者,狭窄与颈动脉分叉部距离≤10mm者高于>10mm者,分叉部伴有钙化灶者高于无钙化灶者(P<0.05)。结论血流动力学紊乱是老年人颈动脉狭窄支架置入术中和术后常见的并发症,高龄、狭窄位置和分叉部钙化是其发生的相关因素,正确的围手术期处理可减少相关并发症的发生。

Objective To study the frequency, prophylactic and treatment measures of hemodynamic instability in elderly patients who underwent carotid angioplasty and stenting （CAS）. Methods All cases of hemodynamic instability were reviewed in a series of 88 eldly patients who underwent CAS, clinical characteristics and angiogram features were analyzed. Resalts The frequency of hemodynamic instability in our patient series was 33% in 88 elderly patients. The incidence of hypotension and bradycardia was significantly higher in patients who was over 70 years old, and it was higher in the patients with carotid stenosis that the distance from carotid bifurcation to stenotic lesion ≤10 mm than the distance 〉10 mm; it was also higher in the patients with calcification at carotid bifurcation （P〈0.05）. Conclusion Periprocedural hemodynamic instabili ty for CAS was the most frequent complication in elderly patients. Elderly patients, the site of stenotic lesion and calcifica tion at carotid bifurcation were related to hemodynamic instability. Properly treatment might decrease the incidence of corn plications duo to hemodynamic instability.