颈动脉支架术高灌注损伤因素分析

Factors predictive of cerebral hyperperfusion after carotid angioplasty and stent placement

目的探讨颈内动脉狭窄支架置入术后高灌注损伤的危险因素。方法颈内动脉狭窄经过颈动脉支架成形术治疗的患者中术后出现高灌注损伤12例和未出现高灌注损伤的56例患者的临床资料进行分析，研究高灌注损伤与高血压、糖尿病、狭窄程度、侧枝代偿情况、血压变化情况、狭窄同侧大脑中动脉血流速度变化的相关性。结果结果提示狭窄程度（B=0．637；P=0．034；OR=1．891）、侧枝代偿情况（B=-1．955；P=0．021；OR=0．142）、血压变化（B=-1．818；P=0．011；OR=0．162）和血流速度的变化（B=1．278；P=0．031；OR=3．59）与高灌注损伤密切相关。结论患者的颈动脉狭窄程度越高，侧枝循环代偿越差，术后血压控制不好，术后同侧大脑中动脉的血流速度越快，则高灌注损伤的危险就越大。

Objective To investigate the predictive factors for cerebral hyper - peffusion after carotid angioplasty and stent placement. Method About 2100 cases were choosen form 2001 to 2009. Two groups were followed. One was Fifty -six patients with carotid artery stenosis treated with stent implantation. This group was normal peffusion. The other group was the cerebral hyperpeffusion group, in which the factors of hypertension, diabetes mellitus, degree of stenosis, compensation of blood vessels, blood pressure,the velocity of blood flow in middle cerebral artery were analyzed retrospectively. Results In the normal group and the cerebral hyperpeffusion group （ cerebral hemorrhage 8 cases were included ） , Logistic regression was suggested that degree of stenosis （ B = 0. 637 ; P = 0. 034 ; OR = 1. 891 ）, compensation of blood vessels（ B = - 1. 955; P =0. 021 ;OR =0. 142） ,blood pressure（ B = - 1. 818; P =0. 011 ;OR = 0. 162）,the velocity of blood flow in middle cerebral artery（ B = 1. 278; P = 0. 031 ;OR = 3.59）were closely correlated with hyperperfusion. Conclusions The risk factors of cerebral hyper - peffusion after carotid angioplasty and stent placement includes severe stenosis, without compensation of blood vessels, high blood pressure, the velocity of blood flow in middle cerebral artery.