血管内支架成形术治疗颈动脉狭窄后血小板活化功能变化的观察

The influence of percutaneous transluminal stenting for stenosis of internal carotid artery on the activation of platelets

目的研究颈动脉狭窄支架植入治疗对患者活化血小板的影响。方法选择临床表现和神经影像学检查符合北美症状性颈动脉内膜剥脱试验（NASCET）纳入标准的患者34例，脑血管造影明确诊断后行颈动脉自膨胀支架植入治疗，术前、术后口服阿斯匹林及氯吡格雷抗栓治疗，并在术前及术后检测患者血小板活化程度，定期随访。结果颈动脉狭窄支架植入治疗后2周内患者CD62P和CD63水平较术前明显增高（均P〈001），3个月后复查下降至术前水平，两者之间相比较无统计学差异（均P〉0．05）。与无狭窄组相比，再狭窄组CD62P和CD63水平升高更明显（均P〈0.05），CD63升高持续时间更长。结论支架植入治疗后急性期存在血小板过度活化状态，且有一定的再狭窄率，这可能是急性期血栓形成及血管内再狭窄的因素之一，应予强化抗血小板治疗。

Objective To investigate the influence of percutaneous transluminal stenting for stenosis of internal carotid artery （ICA） on the activation of platelet. Methods Thirty four patients with ICA stenosis were identified according to the NASCET criteria. Under the guide of roadmap of DSA, self-expandable stents were placed into the stenosis site. The activation of platelets was monitored before and after procedure. Results The levels of CD62p and CD63 were increased significantly in 1N2 weeks after stenting（ P 〈 0.01 ）, but those returned to pre-stenting levels in three months. The levels of CD62p and CD63 were increased significantly in patients with re-stenosis than those without re-stenosis. Conclusion Excessive activation of platelets after stenting may be one of the reasons of thrombogenesis and restenosis.