冠心病冠脉旁路移植术前颈动脉狭窄介入治疗的安全性及有效性研究

Safety and effectiveness of interventional therapy in treatment of stenosis of carotid artery before coronary artery bypass graft surgery

目的探讨冠脉旁路移植术前对狭窄的颈动脉行介入治疗的安全性及有效性。方法共收集了自2013年12月至2016年5月河北医科大学第二医院收治的37例颈动脉狭窄合并严重冠脉病变患者的临床资料,其中男性33例,女性4例,年龄36~72岁,平均年龄(56.4±8.1)岁,所有患者均行冠状动脉造影及脑血管造影确诊为冠脉三支病变合并颈动脉重度狭窄(单侧34例,双侧3例)。所有患者均行颈动脉支架置入术,并在支架置入后7~13d,平均(9.4±2.2)d内行冠脉旁路移植术,对患者的围手术期并发症情况及6个月随访情况进行分析。结果所有患者均成功行颈动脉支架置入术及冠脉旁路移植术,颈动脉支架置入术后出现心率、血压下降10例,对症治疗后好转,围手术期无心绞痛、心肌梗死、脑卒中发生,随访6个月无不良事件发生。结论在冠脉旁路移植术前7~13d行颈动脉支架置入术解决颈动脉重度狭窄安全有效,能提高此类患者手术的安全性及术后生活质量。

Objective To expolre the safety and effectiveness of interventional therapy in treatment of carotid artery stenosis with severe coronary disease patients before coronary artery bypass graft surgery. Method A total of thirty-seven patients with coexistent carotid artery stenosis and coronary artery disease were treated in The Second Hospital of Hebei Medical University during December 2013 to May 2016.The patients, including thirty-three male and 4 female, were aged 36 to 72 （ 56.4±8.1 ） , all patients were diagnosed as coexistent carotid artery stenosis （ 34 unilateral and 3 bilateral ） with coronary artery disease by digital subtraction angiography （ DSA ） and coronary angiography. Coronary artery bypass grafting （ CABG ） was performed within 7-13 （ 9.4±2.2 ） days after carotid artery stenting. The surgical outcomes and 6 months follow-up results were analyzed retrospectively. Results Carotid artery stenting and Coronary artery bypass grafting were achieved in all patients. Transient bradyeardia and hypotension occurred in ten patients while dilating the stent and recovered soon after treatment.There was no angina,acute myocardial infarction and stroke in all cases. Conclusion Carotid artery stenting,7-13 days before CABG, is safe and effective and can improve the safety and quality of life in patients with CABG.