颈动脉内膜剥脱术和支架成形术治疗老年颈动脉狭窄的临床研究

Clinical study of carotid endarterectomy and carotid artery stenting in treating carotid artery stenosis in the elderly

目的探讨颈动脉内膜剥脱术(CEA)和支架成形术(CAS)治疗老年颈动脉狭窄的临床疗效和安全性。方法回顾性分析106例老年(>65岁)颈动脉狭窄患者的临床资料,其中74例行CAS,32例行CEA,分析比较两种方法的成功率、围术期30 d并发症和随访结果。结果CEA和CAS两组成功率(96.8%和100.0%),和围术期30 d内心动过缓(6.3%和4.05%,χ2=0.228,P=0.663)、急性心肌梗死(0.0和1.4%,χ2=0.432,P=0.511)、短暂性低血压(6.3%和8.1%,χ2=0.114,P=0.735)、缺血性脑卒中(6.3%和6.8%,χ2=0.009,P=0.923)、脑过度灌注综合征(18.8%和10.8%,χ2=1.228,P=0.268,)等并发症差异无统计学意义,但CAS组持续性低血压发生率高(3.1%和17.6%,χ2=4.398,P=0.036),随访1年结果显示两组颈动脉再狭窄(中度6.3%和8.1%,χ2=0.114,P=0.735,重度3.1%和2.7%,χ2=0.014,P=0.905)和同侧卒中率发生率(3.1%和5.4%)差异无统计学意义(χ2=0.279,P=0.598)。结论CEA和CAS治疗老年颈动脉狭窄都具有较好疗效,但CAS组术后持续性低血压发生率高于CEA组。

Objective To investigate the clinical efficacy and safety of carotid endarterectomy(CEA)and carotid artery stenting(CAS)for the treatment of carotid artery stenosis in the elderly. Methods Clinical data of 116 elderly patients aged over 65 years with carotid artery stenosis were retrospectively analyzed.Of 116 patients, 73 patients underwent CAS(the CAS group)and 32 received CEA(the CEA group). The success rate, 30-day perioperative complications and follow-up results were compared between the two groups. Results There was no significant difference in the success rate(96.8% vs.100.0%, P>0.05), 30-day perioperative complications, such as bradycardia(6.25% vs.4.5%,χ2=0.228, P=0.663), acute myocardial infarction(0.0 vs.1.4%,χ2=0.432, P=0.511), transient hypotension(6.3% vs.8.1%,χ2=0.114, P=0.735), ischemic stroke(6.3% vs.6.8%,χ2=0.009, P=0.923), and cerebral hyperperfusion syndrome(18.8% vs.10.8%,χ2=0.009, P=0.923), between the CEA and CAS groups.The incidence of persistent hypotension was lower in the CEA group than in the CAS group(3.1% vs.17.6%,χ2=4.398, P=0.036). No significant difference was found in carotid artery restenosis(moderate: 6.3% vs.8.1%,χ2=0.114, P=0.735;severe: 3.1% vs.2.7%,χ2=0.014, P=0.905)and ipsilateral stroke(3.1% vs.5.4%,χ2=0.279, P=0.598)between the CEA and CAS groups at one-year fellow-up. Conclusions Both CEA and CAS have good efficacies in treating carotid artery stenosis in the elderly, while the incidence of persistent hypotension is higher with CAS than with CEA.