颈动脉支架置入术颈动脉窦反应的危险因素：回顾性病例系列研究

Risk factors for carotid sinus reactions during carotid artery stenting： a retrospective case series

目的探讨颈内动脉支架置入术（carotid artery stenting,CAS）时颈动脉窦反应（carotid sinus reaction，CSR）的危险因素。方法回顾性收集36例行颈内动脉颅外段支架置入术的患者资料资料，并按是否发生CSR分为CSR组和无CSR组。采用单变量和多变量logistic回归分析术中发生CSR的危险因素。结果36例患者中25例发生CSR（单纯低血压7例，单纯心动过缓4例，两者共存14例）。CSR组年龄≥75岁（64．00％对27．27％;χ^2=2．384，P=0．028）、颈内动脉狭窄程度70％～99％（76．00％对36．36％；χ^2=4．430，P=0．035）、有症状狭窄（72．00％对36．36％；χ^2=4．082，P=0．043）、钙化斑块（76．00％对36．36％；χ^2=4．430，P=0．035）、狭窄距分叉处距离≤10mm（72．00％对27．27％；χ^2=5．029，P=0．025）和球囊后扩（64．00％对18．18％；χ^2=44．483，P=0．000）的患者构成比显著性高于无CSR组。多变量logistic回归显示，年龄≥75岁[优势比（odds ratio，OR）1．520，95％可信区问（confidence interval，C1）1．376～4．369；P=0．034]、狭窄距分叉处距离≤10mm（OR2．432，95％C12．423～3．421；P=0．041）和球囊后扩（OR3．631，95％C11．764～4．738；P=0．003）是CAS术中发生CSR的独立危险因素。结论CSR是CAS术中的一种常见表现，高龄、狭窄距颈动脉分叉处距离≤10mm和球囊后扩是发生CSR的独立危险因素。

Objective To investigate the risk factors for carotid sinus reactions （CSR） during internal carotid artery stenting （CAS）. Methods The clinical data of 36 patients treated with CAS were enrolled retrospectively. The patients were divided into either a CSR group or a non-CSR group according to whether they had CSR or not. The risk factors for CSR during procedure were analyzed using univariate and multivariate logistic regression analysis. Results Of the 36 patients, 25 had CRS （7 simple hypotension, 4 simple bradycardia, and 14 both co-existence）. The constituent ratios of the patients of the age ≥ 75 years （64. 00% vs. 27. 27%;χ^2 =2. 384, P=0. 028）, degree of CAS 70% to 99% （76. 00% vs. 36. 36%;χ^2 = 4. 430, P = 0. 035）, symptomatic stenosis （72.00% vs. 36. 36% ; χ^2= 4. 082, P = 0. 043）, calcified plaque （76. 00% vs. 36. 36% ;χ^22 =4. 430, P =0. 035）, distance from stenosis to bifurcation ≤ 10 mm （72. 00% vs. 27. 27% ;χ^2 =5. 029, P =0. 025） and balloon expansion （64. 00% vs. 18. 18% ;χ^2 =44. 483, P =0.000） in the CSR group were significantly higher than those in the non-CSR group. Multivariate logistic regression analysis showed that age ≥ 75 years （odds ratio [ OR] 1. 520, 95% confidence interval E CI] 1. 376 - 4. 369; P - 0. 034）, distance from stenosis to bifurcation ≤ 10 mm （OR 2. 432, 95 % CI 2. 423 - 3.421 ; P = 0. 041） and balloon expansion （OR 3. 631, 95% C1 1. 764- 4. 738; P = 0. 003） were the independent risk factors for occurring CSR during CAS. Conclusiom CSR is a common performance during CAS. Advanced age, distance from stenosis to bifurcation ≤10 mm and balloon expansion are the independent risk factors for occurring CSR.