双侧颈动脉狭窄性病变治疗方案的选择与疗效分析

Clinical analysis for different surgical strategies of bilateral carotid stenosis

目的分析双侧颈动脉狭窄患者治疗方案的选择与疗效。方法回顾性分析中国医学科学院阜外医院2016年6月至2019年9月收治的双侧颈动脉狭窄患者43例,其中20例行单侧CEA(单侧CEA组),12例行单侧CAS(单侧CAS组),11例分期先行一侧CAS,再行对侧CEA处理双侧病变(CAS+CEA组),总结不同手术方案的病例特征,观察围术期及术后随访不良事件发生情况。结果单侧CEA组术后发生2例过灌注综合征;单侧CAS组无围术期不良事件;CAS+CEA组7例患者仅一次入院期间完成双侧CAS+CEA分期手术(平均间隔7 d),其余4例合并冠状动脉三支病变的患者在单侧CAS术后1个月接受冠状动脉搭桥术,平均5.5个月后完成对侧颈动脉CEA。患者平均随访22个月,均无卒中事件和死亡发生,单侧CAS组1例患者发生靶血管再狭窄。结论结合双侧颈动脉狭窄患者的特点选择不同治疗方案,并对有指征的患者完成一次入院短时间内行分期CAS+CEA,均取得满意的效果,为双侧颈动脉狭窄性疾病的治疗策略提供了新的参考。

Objective To analysis the different surgical strategies for patients with bilateral carotid stenosis.Methods The clinical data of patients with 43 bilateral carotid stenosis in Fuwai Hospital Chinese Academy of Medical Sciences from June 2016 to September 2019 were analyzed retrospectively.Among them,20 cases underwent unilateral CEA(CEA group),12 cases underwent unilateral CAS(CAS group)and 11 cases received one-sided CAS first,followed by contralateral CEA(CAS+CEA group).We Summarized their clinical characteristics of different surgical strategies,observed the occurrence of adverse events during the perioperative period and the follow-up.Results Two cases suffered hyperperfusion syndrome in the CEA group after surgery.No perioperative adverse event occurred in the CAS group.Seven patients in the CAS+CEA group completed the staged CAS+CEA performance during only one hospitalization(mean interval of 7 days).The remaining 4 patients with coronary artery disease with triple vessel lesion underwent coronary artery bypass grafting after the unilateral CAS,then staged contralateral CEA were performed after a mean interval of 5.5 months.Patients were followed up for an average of 22 months,no stroke event or death occurred.One patient in the CAS group had target vessel restenosis.Conclusion An appropriate surgical strategies should be based on the characteristics of patients with bilateral carotid artery stenosis and staged CAS+CEA during only one hospitalization are completed in indicated patients with satisfactory results,providing new reference for treatment strategy of bilateral carotid artery stenosis diseases.