脑血管金属支架植入脑动脉血管血栓形成的风险评估

Risk assessment of cerebral thrombosis after implantation of metal stent via cerebral vascular intervention

目的:探讨脑血管介入金属支架植入后脑动脉血管血栓形成的风险。方法:回顾性总结2009年1月-2010年1月在我科行脑血管介入治疗,并有金属支架植入的病例87例,并对其术后情况进行跟踪随访2年,监测其血清D-二聚体(D-dimer)水平及血小板聚集性水平。应用单因素分析和Logistic回归方法找出急性、亚急性期和晚期新发脑梗死的危险因素。结果:本组患者2年内新发脑梗死11例,占到12.64%,其中在支架植入术后急性、亚急性发生7例,晚期4例。患者未按时服用阿司匹林、肾功能异常、心脏支架病史、血小板聚集水平高是急性、亚急性期发生新发脑梗死的危险因素(P<0.05或P≈0.05),高血压、未按时服用阿司匹林、糖尿病是动脉支架植入晚期血栓形成的危险因素(P<0.05)。未按时服用阿司匹林则是两者共同的独立危险因素。结论:脑血管介入金属支架植入后,若规范应用抗血小板聚集性治疗,可能会降低再发脑梗死的风险。

Objective ：To discuss the risk of cerebral thrombosis after implantation of metal stent via cerebral vascular intervention. Methods：Clinical data of 87 patients who underwent implantation of metal stent via cerebral vascular intervention in our department during 2009-2010 were retrospectively summarized, and the postoperative conditions were followed for 2 years. Serum D-dimer level and platelet level were monitored. Risk factors of new cerebral infarction at acute, subacute and advanced stages were tested by single factor analysis and Logistic regression. Results：There were 11 cases（12.64%） with new cerebral infarction after metal stent implantation, 7 at acute and subacute stages while 4 at advanced stage. Not taking aspirin on schedule, renal dysfunction, history of heart stent disease,higher level of platelet aggregation were high risk factors of new cerebral infarction at acute and subacute stages（P〈0.05 or P=0.05）,while hypertension, not taking aspirin on schedule,diabetes, hyperlipidemia were high risk factors of cerebral thrombosis formation at advanced stage（P〈0.05）. Failure to take aspirin on schedule was the independent risk factor at all stages. Conclusions： Regular using of anti-platelet aggregation therapy may reduce the risk of ischemic stroke after metatl stent implantation via cerebral vascular intervention.