80岁及以上患者行颈动脉支架置入术的临床观察与随访

Carotid artery stenting in octogenarians:Clinical observation and follow-up

目的观察80岁及以上颈动脉狭窄患者行支架置入术(CAS)的安全性与长期有效性。方法回顾2008年7月至2017年10月因颈动脉狭窄于本中心接受CAS术的年龄≥80岁患者的临床资料,分析其围手术期治疗情况与中长期随访结果。结果共纳入61例患者(中位年龄81岁,男54例),其中23例(37.7%)患者为症状性颈动脉狭窄。60例患者行单侧CAS术,1例同期行双侧CAS术,26例(42.6%)同期行其他脑血管介入治疗,技术成功率100.0%。围手术期任何脑卒中的发生率为6.6%(4/61),无死亡病例。术后8例(13.1%)患者发生造影剂肾病,4例(6.6%)发生心功能不全,30例(49.2%)出现持续性低血压需应用升压药物,经治疗均恢复。全部病例随访2~108个月,中位随访时间42个月(四分位间距44个月)。术后30 d至1年脑卒中和死亡的发生率为8.2%(5/61);症状性颈动脉狭窄患者中位无卒中生存期为72个月,无症状性颈动脉狭窄患者中位无卒中生存期为93个月,差异有统计学意义(χ^2=4.258,P=0.039)。结论80岁及以上颈动脉狭窄患者行CAS术具有较好的安全性与可行性,需要在经验丰富的中心进行,中长期随访效果良好。

Objective To observe the safety and long-term efficacy of carotid artery stenting(CAS)in octogenarians with carotid stenosis.Methods Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid-and long-term follow-up results were analyzed.Results A consecutive series of 61 patients(a median age of 81 years,54 males)were enrolled.Of 61 patients,23(37.7%)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS,one patient underwent bilateral CAS,and 26(42.6%)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0%.During the perioperative period,the incidence of stroke was 6.6%(4/61),and no patient died.Eight(13.1%)patients had contrast-induced nephropathy,4(6.6%)patients suffered from cardiac dysfunction,and 30(49.2%)patients had hypotension requiring vasopressor support postoperatively,and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months,with an interquartile interval of 44 months).The incidence of stroke and death was 8.2%(5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis,and was 93 months in asymptomatic patients,with the statistically significant difference between the two groups(χ^2=4.258,P=0.039).Conclusions Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers,and the outcome of a mid-and long-term follow-up is good.