颈动脉内膜剥脱术和颈动脉支架成形术治疗缺血性脑卒中的中期效果比较:单中心经验

The mid-term outcome of carotid endarterectomy and carotid stenting in the treatment of ischemic stroke:a single-center experience

目的探讨颈动脉内膜切除术(CEA)和颈动脉支架成型术(CAS)治疗缺血性脑卒中的近中期效果及围术期并发症。方法根据入组标准将颈动脉重度狭窄病例随机入组(CEA组71例,CAS组108例),比较两组围术期卒中、死亡、心梗及并发症发生率,门诊随访记录卒中、死亡、心梗及再狭窄率,比较两组临床结局。结果两组手术技术成功率100%,CEA组30天总卒中发生率显著低于CAS组(2.82%vs 12.04%,P=0.029),两组大卒中、小卒中各自发生率差异无统计学意义(P>0.05);两组30天死亡、心肌梗死发生率差异无统计学意义(P>0.05),但死亡仅出现在CAS组。CEA和CAS组高灌注综合征发生率差异无统计学意义(11.27%vs 13.89%,P=0.61);CEA组术后高血压发生率高(8.45%vs 2.78%,P=0.04),CAS组低血压发生率高(1.41%vs 10.19%,P=0.046)。两组切口血肿发生率差异无统计学意义(5.63%vs 9.26%,P=0.38)。平均随访24.7月,两组总卒中/短暂性脑缺血发作、同侧卒中、死亡发生率差异无统计学意义(P>0.05);但CAS组总卒中/死亡率高于CEA组(13.55%vs4.22%,P=0.045)。CAS组再狭窄(>50%)发生率明显高于CEA组(13.46%vs 4.22%,P=0.043),再狭窄多引起非致残性卒中复发。结论 CEA和CAS均可有效预防卒中,CAS有更高的围术期卒中/死亡发生率,CEA具有更低的再狭窄率,术后再狭窄往往导致术后非致残性卒中复发。

Objective To investigate the mid-term outcome and perioperative complications of carotid endarterectomy（CEA） and carotid stenting（CAS） in the treatment of ischemic stroke. Methods The patients with severe carotid stenosis were enrolled according to the inclusion criteria. 71 patients in the CEA group and 108 in the CAS group were enrolled in the study. Baseline data, incidence of perioperative and postoperative stroke, death, myocardial infarction and complications were recorded. The followup of patients were carried out at outpatients, the clinical outcomes of two groups were compared. Results The success rate of surgical technique was 100% in both groups. The incidence of total stroke at 30 days in CEA group was significantly lower than that in CAS group（2.82% vs 12.04%, P =0.029）. There was no significant difference between the two groups in incidence of classification of stroke and myocardial infarction between the two groups at 30 days（P〈0.05）, but only death occurred in the CAS group. There was no significant difference in incidence of high perfusion syndrome in both groups（11.27% vs 13.89%,P =0.61）. The incidence of postoperative hypertension was significantly higher in CEA group（8.45% vs2.78%, P =0.04） and hypotension was higher in CAS group（1.41% vs 10.19%,P =0.046）. There was no significant difference in total stroke/transient ischemic attack, ipsilateral stroke and death between the two groups（P〈0.05）. However, the total stroke/death rate was higher in CAS group（13.55% vs 4.22%, P=0.045）. The incidence of restenosis（ 50%） was higher in CAS group（13.46% vs 4.22%, P =0.043）.Conclusions CEA and CAS are effective in preventing stroke. CAS has a higher incidence of perioperative stroke/death and CEA has a lower rate of restenosis. Postoperative restenosis often leads to postoperative non-disabling stroke recurrence.