颈动脉内膜剥脱术与颈动脉支架置入术治疗颅外颈动脉狭窄的临床疗效比较

Clinical Efficacy Comparison Between Carotid Endarterectomy and Carotid Artery Stenting on Extracranial Carotid Stenosis Treatment

目的比较颈动脉内膜剥脱术(carotid endarterectomy,CEA)与颈动脉支架置入术(carotid stenting,CAS)治疗颅外颈动脉狭窄的临床疗效,为颅外颈动脉狭窄的CEA和CAS治疗提供更丰富的临床循证医学证据。方法将40例有手术指征的颈动脉狭窄患者按治疗方法的不同分为CEA组和CAS组。2组患者均行相应手术治疗,观察、比较其临床疗效。结果 2组患者围术期并发症发生率、术后3个月2组患者的心血管并发症、脑卒中及死亡等主要终点事件发生率的差异均无统计学意义(P>0.05);随访12个月,2组术侧颈动脉再狭窄、致残或致死性卒中发生率比较差异也无统计学意义(P>0.05)。结论对于具有手术指征的颅外颈动脉狭窄患者,CEA与CAS具有同样的临床疗效,且安全性均较高;但仍需要大样本多中心长期循证医学证据支持。

Objective To compare the clinical efficacy of carotid endarterectomy （CEA） and carotid artery stenting （CAS） in the treatment of patients with carotid artery stenosis, and to provide a more abundant evidence-based medicine for the treatment of CEA and CAS in patients with carotid artery stenosis. Methods Forty patients with carotid artery stenosis were randomly divided into CEA group and CAS group based on the operative indication. Patients in CEA group were given carotid endarterectomy treatment and those in CAS group were given carotid artery stenting treatment. Then clinical efficacy of the two groups were observed and compared. Results In terms of the occurring rate of perioperative complications, cardiovascular events in 3 months after operation, and some major end events such as stroke, death and so on, the comparative difference between the two groups was of no statistical significance （P〉0.05）. Through the followed- up visits of 12 months, the comparative difference between the two groups was also of no statistical significance （P〉0.05） in terms of the occurring rate of carotid artery restenosis and disabling or fatal stroke. Conclusions For patients with severe extracranial carotid stenosis under indication of operation treatment, carotid endarterectomy and carotid artery stenting are of equivalent clinical efficacy, and both of them are of high security, although further study with large- amount and evidence-based medical data in long term from multiple centers is still in need.