术中加压冲洗对颈动脉支架成形术术后脑卒中发生的影响

The effect of pressure flushing during operation on occurrence of stroke after carotid artery stenting

目的探讨术中脑保护下加压冲洗技术对颈动脉支架成形术(carotid artery stenting,CAS)术中及术后脑卒中发生的影响。方法回顾性分析2016年6月至2018年6月于首都医科大学宣武医院血管外科行CAS治疗的202例颈动脉狭窄患者资料,按照患者术中是否进行加压冲洗分为加压冲洗组(90例)和对照组(112例),分析CAS术后脑卒中发生的高危因素以及术中加压冲洗对脑卒中发生的影响。结果患者均顺利完成CAS,术后加压冲洗组发生脑卒中2例(2.2%),对照组发生脑卒中6例(5.4%),但差异无统计学意义(P>0.05)。对术后脑卒中进行COX回归分析提示,陈旧性脑梗死病史是术后脑卒中发生的独立危险因素(P=0.004),而加压冲洗是其保护因素(P=0.029)。结论CAS术中脑保护下加压冲洗可以降低术后脑卒中的发生,但还需要进一步的研究提供更充分的证据。

Objective To investigate the effect of intraoperative pressure flushing under cerebral protection on the occurrence of stroke during and after carotid artery stenting(CAS).Methods The clinical data of 202 patients with carotid stenosis who underwent CAS from June 2016 to June 2018 in Department of Vascular Surgery,Xuanwu Hospital of Capital Medical University were analyzed retrospectively.They were divided into pressure flushing group(90 cases)and control group(112 cases)according to whether underwent pressure flushing or not.The high-risk factors of stroke after CAS and the influence of pressure flushing on the occurrence of stroke during CAS were analyzed.Results All patients completed CAS successfully.Two cases(2.2%)occurred postoperative stroke in the pressure flushing group and 6 cases(5.4%)occurred in the control group,but the difference was not statistically significant(P>0.05).The COX regression analysis of postoperative stroke indicated that the history of past cerebral infarction was an independent risk factor for postoperative stroke(P=0.004),and pressure flushing was a protective factor(P=0.029).Conclusion Pressure flushing under cerebral protection is a safe and effective technique in CAS which can reduce the incidence of postoperative stroke,but further research is needed to provide more sufficient evidence.