颈动脉狭窄经皮血管腔内成形术和支架植入治疗的临床及随访研究

Following-up study in managing the percutaneous transluminal angioplasty and stenting for the carotid artery stenosis

目的 对颅外颈动脉狭窄 (ECCAS)病人的临床特征和应用经皮血管成形术 (PTA)加支架植入术 (CAS)治疗的效果进行随访研究。方法 选择 2 9例严重颈动脉狭窄病人 (狭窄程度≥70 % ) ,记录每例临床特征、脑血管和冠状动脉造影结果 ,并做PTA +CAS ,术前和术后 2 4h均进行NIHSS评分 ,术后 6个月复查血管造影 ,所有病例临床随访 1年。同时选取 12 1例冠状动脉造影证实为冠心病 (CAD) ,而脑血管造影正常的患者作为对照组。结果 ECCAS患者的年龄、吸烟、冠状动脉损害程度与冠心病组比较差异无显著意义 ,有高血压病史、糖尿病史、周围血管病 (PVD)史的患者明显多于冠心病组。PTA +CAS手术成功率为 96 6 % ,病死率为 0 ,住院期间卒中发生率为 3 5 %。术后2例出现癫痫 ;术后 6个月随访血管造影再狭窄率为 3 5 % ,术后 1年临床随访无短暂性缺血发作(TIA)和脑梗死发病患者。结论 ECCAS与脑血管病、PVD和CAD有明显联系 ,PTA +CAS是治疗ECCAS和预防卒中较安全。

Objective To study the clinical characteristics, the treating effects on percutaneous transluminal angioplasty (PTA) and the carotid artery stenting (CAS) in patients with extracranial carotid artery stenosis Methods Twenty nine patients with severe extracranial carotid artery stenosis (ECCAS) (degree of stenosis>70%) underwent a treatment of PTA+CAS Patient's clinical features and the results of coronary and cerebrovascular angiography were noted and analysed Neurological status of the patients before operation and 24 hours after stenting were assessed using the NIHSS All patients undergoing angiography were successfully accomplished with six months follow up We selected 121 patients with angiographically documented coronary artery disease (CAD) and those without cerebrovascular abnormal as controls Results The age, smoking history, degree of coronary artery lesions were found similar between ECCAS and CAD groups Hypertension, diabetes mellitus, concomitant peripheral vascular disease (PVD) in patients of ECCAS group were significantly higher than those in CAD group The technical successful rate of PTA+CAS was 96 6% The mortality rate of the patients suffered from strokes was in 3 5% during hospitalization Two patients developed epileptic seizures in other operation The restenosis rate was 3 5% at follow up The patients did not discover TIA and stroke at one year follow up Conclusion ECCAS should be closely related to the cerebrovascular disease, PVD and CAD PTA+CAS should be of safety and efficacy for ECCAS treatment and stroke prevention