同期联合支架术治疗并存颈动脉和肾动脉狭窄的近中期疗效分析

Short- and medium-term results of simultaneous carotid and renal artery stenting for coexisting carotid artery and renal artery stenosis

目的 探讨同期联合支架术治疗并存颈动脉和肾动脉狭窄的安全性和有效性.方法 回顾性分析同期联合支架术治疗的30例并存肾动脉狭窄和颈动脉狭窄患者.纳入标准为外周动脉造影示肾动脉管腔内径减少≥70%且颈总动脉或颈内动脉管腔内径减少≥70%.术后随访12个月,观察治疗前后血压、降压药物种类、肾功能及心脑血管事件发生情况.结果 30例患者均成功进行介入治疗.患者术后收缩压由术前（135.93±23.02） mmHg降至（123.07±12.62）mmHg（术后3d平均收缩压）（P＜0.05）,舒张压由术前（76.13±8.75）mmHg降至（70.87±6.42）mmHg（术后3d平均舒张压）（P＜0.05）.2例冠心病患者术后心绞痛再发,经处理后缓解.术后平均随访12个月,收缩压降至（122.33±7.39） mmHg,舒张压降至（70.87±8.62）mmHg（P＜0.05）;服用降压药物种类由术前（2.93±1.87）种减少为（2.40±2.13）种（P＜0.05）.高血压获益率为100.0%,肾功能获益率为76.6 %.2例患者分别于术后3个月和7个月心绞痛再发和短暂脑缺血发作,予处理后缓解.结论 同期联合支架术治疗并存肾动脉和颈动脉狭窄近中期疗效安全、满意,远期疗效有待进一步随访.

Objective TO evaluate the safety and effectiveness of simultaneous carotid and renal artery combined stenting for coexisting carotid artery and renal artery stenosis. Methods Thirty patients with coexisting carotid artery and renal artery stenosis （luminal narrowing ≥ 70%） underwent combined stenting in Fuwai Hospital from September 2008 to December 2010. The therapeutic effects were evaluated by means of blood pressure, types of hypotensors, renal function and the incidence of cardiovascular and cerebrovascular events before and after therapyin average 12 months follow-up after operation. Results The interventional treatment was successful in all 30 patients. Systolic blood pressure decreased from（135.93 ±23.02） mmHg before intervention to （123.07± 12.62）mmHg 3d after intervention（P〈0.05）; diastolic blood pressure decreased from（76.13 ± 8.75） mmHg before intervention to（70.87± 6.42） mmHg 3d after intervention（P〈0.05）. Only two patients with coronary heart disease suffered from angina after intervention, the symptom was completely relieved after symptomatic treatment. By 12 months follow-up, systolic blood pressure decreased to（122.33 ± 7.39）mmHg（P〈0.05）; diastolic blood pressure decreased to （70.87 ± 8.62）mmHg（P〈 0.05）, the number of hypotensors reduced from 2.93 ± 1.87 to 2.40 ± 2.13 （P〈0.05）. The overall beneficial rate of hypertension appeared to be 100.0%; the overall beneficial rate of renal function appeared to be 76.6%. One case with coronary heart disease suffered from angina 3 months after intervention, another case suffered from transient ischemic attack 7 months after intervention, the symptoms of both patients were completely relieved after symptomatic treatment. Conclusion The short- and medium-term results of simultaneous carotid and renal artery combined stenting for coexisting carotid artery and renal artery stenosis are safe and satisfactory, while long-term effect needs to be further studied.