老年人颈动脉狭窄支架置入术并发症的预防和处理

Prevention and treatment of complications of carotid angioplasty and stenting in the elderly.

目的总结老年人颈动脉狭窄支架置入术（carotid endartrectomy，CEA）并发症的发生、预防和处理方法。方法收集我院收治的行CAS的老年患者88例，回顾性分析并发症的防治措施。结果88例患者共置入支架92个，均为自膨式支架，支架置入成功率100％，平均狭窄率由术前的84．6％下降至13．2％。所有患者随访3～12个月。发生颈动脉窦反应23例，占26．1％。70～79岁组和80岁以上组与60～69岁组比较，差异有统计学意义（P〈0．05）。狭窄与颈动脉分叉部的距离≤10mm者与〉10mm者比较，差异有统计学意义（P〈0．05）。高血压（收缩压〉160mmHg）6例，高灌注综合征4例，其中颅内出血1例；缺血性脑卒中1例，脑血管痉挛4例，肾功能不全3例，穿刺部位淤斑或血肿7例。随访期间发生短暂脑缺血发作（TIA）3例，心肌梗死1例，脑出血1例。遗留轻度神经功能障碍2例，无死亡病例。结论老年人CAS风险相对较高，正确预防和处理可以降低并发症的发生。

Objective To summarize the prevention and treatment of complications of carotid angioplasty and stenting （CAS） in the elderly. Methods 88 cases （≥60 years） who underwent carotid angioplasty and stenting were collected from our hospital. The prevention and treatment of complications were analyzed retrospectively. Results Ninety two self-expanding stents were placed in the 88 cases and the technical success rate was 100%. The degree of stenosis was significantly improved from 82.6% to 13.2%. All patients were followed up for 3-12 months. Carotid sinus reaction was observed in 23 cases （26. 1%） and it was more often in ≥70 years group than in 60-69 years group （P〈0.05）. Meanwhile, compared with the distance 〉10 mm, Carotid sinus reaition was more often in the distance ≤10 mm between carotid bifurcation and maximum stenotie lesion （P〈 0.05）. Hypertension occurred in 6 cases, cerebral hyperperfusion syndrome in 4 cases including 1 case of cerebral hemorrhage. There were cases with cerebral ischemia in 1 case, cerebralvascular spasm in 4 cases, acute renal insufficiency in 3 cases and ecchymosis and hematoma at the puncture site in 7 cases. There were 3 cases of transient ischemic attack, 1 case of myocardial infarction, 1 case of cerebral hemorrhage, 2 cases of mild neurological deficits and no death occurred during the period of follow-up. Conclusions There is higher risk for elderly patients undergoing CAS, but careful preoperative preparation and properly treatment may avoid the occurrence of complications.