多发颈动脉重度狭窄/闭塞患者的临床干预研究

The clinical intervention and follow-up study on multiple severe carotid stenosis or occlusion

目的评价血管内支架置入术和内科药物治疗双侧重度颈动脉狭窄/闭塞患者的疗效。方法一侧颈动脉闭塞,对侧颈动脉重度狭窄患者21例,随机分成两组:A组8例,接受颈动脉血管内支架置入治疗;B组13例,接受内科药物治疗。临床和超声波随访1年半。结果A组患者术前颈动脉狭窄程度为70%～98%,颈内动脉支架放置成功,术后狭窄程度小于10%,除1例偶发一次TIA外,其他患者未再出现TIA和卒中发作,颈动脉超声随访1年半,未见明显的管腔再狭窄(狭窄≥30%)。B组患者9例(9/13)再次卒中(5例发生脑梗死,其中2例死亡,4例反复TIA),另4例(4/13)病情无变化,超声波检查发现7例(7/11)患者颈动脉内中膜增厚、动脉粥样斑块增多增大,管腔进一步狭窄。结论血管内支架置入术是治疗双侧颈动脉重度狭窄/闭塞安全有效的治疗手段,其短-中期疗效优于内科药物治疗。

Objective To evaluate the effectiveness of endovascular stenting and internal treatment for patients with severe carotid stenosis ,combined with contralateral carotid occlusion. Methods 21 patients with severe carotid arterial stenosis,combined with contralateral carotid occlusion were divided into two groups randomly, Group A（8 patients） were treated through endovascular stent approach and Group B（13 patients） were treated by medicine. Follow-up was performed clinically and by ultrasound of carotid for 18 months. Results All 8 procedures succeeded technologically in Group A,the stenotic degref of the lesions before procedures was 70%～ 98%, and the residual stenosis after procedures were less than 10%. Except one patient had TIA once,neither new stroke nor TIA had happened. No significant intima hyperplasia was detected inside the stents. In the Group B stroke had happened in 9 patients （cerebral infarction in 5 patients,2 of them died ,4 patients had recurrent TIA）, Others（4 patients） had not changed. Results of carotid ultrasound in 7 patients （7/ll）showed that the carotid inner-middle membrane significantly thicken,the size and rank of carotid artery atheromatous plaque significantly increased,carotid stenosis extent deteriorated. Conclusion Endovacular stenting is a effective approach for patients with bilateral carotid stenosis or occlusion,and is more effective than internal treatment in a short or middle term.