颈动脉狭窄支架成形术预防缺血性脑卒中的临床价值

Clinical value of Carotid artery s stenting in prevention of ischemic stroke

目的观察并探讨颈动脉狭窄支架成形术(carotid artery stenosis stenting,CASS)对缺血性脑卒中(ischemic stroke,ICS)的预防价值。方法选择自2010年2月—2013年12月在温岭市第一人民医院治疗的颈动脉狭窄(carotid artery stenosis,CAS)患者96例,按照随机分组法将其分为2组,观察组和对照组各48例,对照组给予单纯药物治疗,观察组接受CASS术治疗。治疗前后监测2组患者的甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)和CAS程度,并随访统计2组预后情况。结果治疗前,2组患者血脂水平相比差异不具有统计学意义(P>0.05);治疗后,观察组TG、TC、LDL分别为(1.42±0.36)mmol/L、(3.15±0.32)mmol/L和(2.01±0.24)mmol/L,对照组为(1.76±0.43)mmol/L、(3.96±0.92)mmol/L和(2.52±0.34)mmol/L,2组相比差异具有统计学意义(P<0.05);观察组CAS重度率为2.1%(1/48),对照组为18.8%(9/48),2组差异具有统计学意义(P<0.05);观察组颈动脉短暂性缺血发作(transient ischemic attack,TIA)、ICS、新发梗死及病死率均明显低于对照组(P<0.05)。结论对CAS患者实施CASS术有利于控制狭窄程度,并预防ICS的发生,是安全有效的治疗方法。

Objective To explore the clinical value of carotid artery stenting （CAS） in the prevention of ischemic stroke （ICS）. Methods A total of 96 patients with CAS in this hospital from February 2010 to December 2013 were selected and were randomly divided into two groups with 48 eases in each group, the control group was treated with drug alone, while the observation group accepted CASS. The level of triglyceride（ TG）, total cholesterol（ TC ）, low-density lipoprotein （LDL） ,and CAS severity in both groups were detected before and after the treatment,the adverse events were also recorded. Results The difference of lipid levels between the two groups before the treatment was not statistically significant （ P 〉 0.05 ） ; after the treatment, TG, TC and LDL in the observation group was （ 1.42 ± 0.36 ） retooL/L, （ 3.15 ± 0.32 ） mmoL/L and （ 2.01± 0.24 ） mmol/L, respectively, and in the control group was （ 1.76 ± 0.43 ） mmol/L, （ 3.96 ± 0.92 ） mmol/L and （ 2.52 ± 0.34 ） retool/L, respectively, the difference was statistically significant（ P 〈 0.05 ） ; the rate of CAS severe in the observation group was 2.1% （1/48）, while in the control group was 18.8% （9/48）, the difference was statistically significant （ P 〈 0.05 ） ; the incidence of carotid transient ischemic attack （ TIA ）, ICS, new discovery infarction and death in the observation group were significantly lower than those in the control group （ P 〈 0.05 ）. Conclusion CASS can control the degree of stenosis in patients with CAS, and prevent the occurrence of ICS, thus is safe and effective treatment methods.