颈动脉分叉部支架成形术中支架直径与术后血流动力抑制的相关性分析

Correlation between the Diameter of Stent and Hemodynamic Depression after Carotid Bifurcation Stenting

目的探究在颈动脉分叉部支架成形术中,留置支架的直径与发生血流动力抑制的(Hemodynamic Depression,HD)相关性。方法总结我科104例颈动脉粥样硬化性重度狭窄接受支架成形术的患者,将其分为A、B两组。A组46例,依据传统方法选择支架直径;B组68例选择较小直径支架。比较分析直径、球囊直径与对术后的狭窄率、HD发生率的相关性。结果 104例颈动脉粥样硬化性重度狭窄的患者在行颈动脉支架成形术后,症状都得到改善。A组留置支架直径(9.1±0.3)mm,B组留置的支架直径为(8.3±0.2)mm,两组存在显著差异;A组21名(45.7%)发生HD;B组10名(14.7%)发生HD,两组存在显著差异,留置支架直径较小组HD发生率低。两组球囊直径分别为(4.9±0.2)mm及(4.8±0.1)mm,无显著差异;两组患者支架成形术前狭窄率分别为(76±9)%及(74±8)%,无显著差异;两组患者支架成形术后狭窄率分别为(15±6)%及(17±10)%,无显著差异。A组患者1例出现术后脑血症状,B组患者未出现相关脑缺血症状。Logistis回归分析显示A组(大直径)发生HD的风险是B组(小直径)的4.405倍。结论选用较大支架会更易发生术后HD。与之相比,选用较小直径的支架会减少HD发生率,并且可以使狭窄病变获得相同程度的改善。

Objective To investigate the correlation between the diameter of the stent implanted in carotid artery bifurcation and hemodynamic depression（HD） post carotid artery stenting（CAS）.Methods A total of 104 patients treated with stent angioplasty at bifurcation of carotid artery due to the stenosis of atherosclerosis were collected in our hospital.All patients were divided into two groups： A group who were implanted with larger diameter stent according to the traditional principle,and B group who were implanted with smaller diameter stent.The correlation between the stenosis rate before/post operation,diameter of the stent,the diameter of the balloon and the risk rate of HD were analyzed retrospectively.Results The symptoms were improved in all of the patients after CAS.Diameter of the stents in group A were（9.1±0.3）mm compared with the diameter（8.3±0.2）mm in group B（P〈0.01）.HD were happened in 21 cases（45.7%） in group A compared with 10 cases（14.7%） in group B（P〈0.01）; The stenosis rate were（76±9）% and（74±8）%,and the diameter of the expanding balloon were（4.9±0.2）mm and（4.8±0.1）mm respectively.Ischemic evidence were happened in one case in group A,but none in group B.Conclusions In CAS of carotid bifurcation,more risk of HD after procedure were found in the cases implanted larger diameter stent,but less risk and coequality improvement in stenosis were found in the cases implanted smaller diameter contrarily.