高龄颈动脉狭窄患者颈动脉内膜切除术和颈动脉支架成形术的安全性比较

Comparison between outcomes of carotid endarterectomy and carotid artery stenting in treating elderly patients

目的回顾接受颈动脉内膜切除术和颈动脉支架成形术的高龄(≥70岁)颈动脉狭窄患者的临床资料,分析手术安全性。方法共691例颈动脉狭窄患者,121例行颈动脉内膜切除术、570例行颈动脉支架成形术,分析两组患者危险因素、临床特征和术后并发症发生率,评价两种手术方法之安全性。结果术后30 d时,两组患者病死率(0.83%对1.05%,P=1.000)、脑卒中(4.13%对1.93%,P=0.258)和心肌梗死(0.83%对0,P=0.175)发生率差异均无统计学意义;但颈动脉内膜切除术组患者术后心脏不良事件(8.26%对1.05%,P=0.000)和脑神经损伤(4.96%对0,P=0.000)发生率高于颈动脉支架成形术组,而窦性心动过缓或低血压发生率低于颈动脉支架成形术组(0对7.54%,P=0.002)。结论高龄患者接受颈动脉内膜切除术或颈动脉支架成形术均有较高的安全性,术前应全面评价患者基础情况,以减少术后并发症发生率。

Objective To review the clinical data of elderly patients treated by carotid endarterectomy （CEA） and carotid artery stenting （CAS）, and analyze the safety of two kinds of surgery. Methods A total of 691 patients with carotid artery stenosis underwent CEA （121 cases） and CAS （570 cases） respectively. The risk factors, clinical symptoms and postoperative complications in 2 groups of patients were analyzed, and the safety of two kinds of surgery were assessed. Results After 30 d of operation, no significant difference was found between 2 groups in death rate （0.83% vs 1.05%, P = 1.000）, stroke rate （4.13% vs 1.93%, P = 0.258） or myocardial infarction rate （0.83% vs 0, P = 0.175）. Heart complications and cranial nerve injury rate in CEA group was significantly higher than that in CAS group （8.26% vs 1.05%, P = 0.000; 4.96% vs 0, P = 0.000）, while sinus bradycardia or hypotension rate in CEA group was significantly lower than that in CAS group （0 vs 7.54%, P = 0.002）. Conclusions Both CEA and CAS are safe for the elderly patients. However, the conditions of elderly patients should be evaluated before operation in order to reduce oceurence of complications after operation.