颈动脉狭窄血管内支架置入安全性的系统评价

Safety evaluation of endovascular stent implantation in treating carotid artery stenosis

目的:评价血管内支架置入在颈动脉狭窄治疗中的安全性,分析支架置入后颈动脉狭窄率和血流动力学的变化。方法:以计算机检索方法在中国期刊全文数据库中(CNKI:2000/2008)检索关于颈动脉狭窄血管内支架治疗的自身前后对照实验,检索词为"颈动脉狭窄、血管内支架置入"。检索后对每项研究的资料结果进行提取、分析。结果:共有17项实验522例颈动脉狭窄患者符合纳入标准,血管内支架置入后颈动脉狭窄率均较术前降低,随访结果显示支架形态良好、无变形、支架处血流通畅,无血管内再狭窄发生。同时支架置入可使狭窄段血流速度恢复,提高远端的血流速度,有效改善脑血流灌注和血流动力学障碍,减少脑卒中的发生。结论:血管内支架置入治疗颈动脉狭窄的成功率高,具有很好的临床效果,但由于纳入试验少,证据的强度不足,其他有效性指标和安全性,有待更多证据加以评价。

OBJECTIVE： To evaluate the safety of endovascular stent implantation in treating carotid artery stenosis and analyze the stenosis rate and hemodynamics following stent implantation. METHODS： Self-control experiments concerning endovascular stent implantation for carotid artery stenosis were searched in CNKI published between 2000 and 2008 with the keywords of ＂carotid artery stenosis, endovascular stent implantation＂. The data of each experiment were extracted and analyzed. RESULTS： A total of 17 experiments involving 522 cases of carotid artery stenosis were accorded with the inclusion criteria. The stenosis rate was reduced after endovascular stent implantation. Follow-up results show that the stent has good appearance with no deformation, and the blood flow is patent in the stent, with no relapse of re-stenosis. In addition, stent implantation promotes recovery of blood flow at stenosis site, improves distal blood flow rate, attenuates blood perfusion and hemodynamic impairment and reduce stroke incidence. CONCLUSION： Endovascular stent implantation has high success rate in treating carotid artery stenosis with favorable clinical outcome. However, other effective indexes and its safety need further evaluation.