颈动脉支架置入术后发生高灌注脑出血的危险因素分析

Analysis of risk factors for HICH after cervical CAS

目的探讨颈动脉支架置入术(CAS)后发生高灌注脑出血(HICH)的危险因素。方法选取南阳市中心医院既往实施CAS手术治疗的症状性颈动脉重度狭窄患者为研究对象,其中18例患者在CAS术后出现颅内出血(HICH组),选取年龄及性别基本与HICH组匹配的54例CAS手术患者为对照组,对比2组患者的年龄、性别、血压、血脂、血糖、吸烟、饮酒、合并疾病等基础资料,分析可能导致症状性颈动脉重度狭窄患者实施CAS后发生HICH的危险因素。结果HICH组和对照组年龄、性别、吸烟、饮酒、BMI、DBP、TG、TC、HDL-C、LDL-C、血糖比较差异均无统计学意义(P>0.05);HICH组患者冠心病合并率27.78%,侧支循环不良率44.44%,颈动脉狭窄程度(81.33±4.50)%,SBP(137.2±10.7)mmHg,均高于对照组[分别为7.41%、16.67%、(78.20±4.13)%、(132.0±8.4)mmHg],差异均有统计学意义(P<0.05)。经Logistic回归分析,CAS术后侧支循环不良、颈动脉狭窄程度增大、SBP测定值增大是症状性颈动脉重度狭窄患者实施CAS后发生HICH的独立危险因素(OR值分别为1.941、2.257、0.044,P<0.05)。结论CAS术后侧支循环不良、颈动脉狭窄程度增大、SBP增大可能会增加症状性颈动脉重度狭窄患者实施CAS后发生HICH风险。

Objective To investigate the risk factors for HICH in patients with symptomatic carotid stenosis after CAS.Methods Patients with symptomatic carotid artery stenosis who underwent CAS surgery in our hospital were selected as subjects.Among them,18 patients had intracranial hemorrhage after CAS(HICH group),and 54 CAS patients with age and gender matched with HICH group were selected.Patients were selected as a control group to compare the age,sex,blood pressure,blood lipids,blood glucose,smoking,alcohol consumption,and history of the disease in the two groups.The risk factors for HICH in patients with symptomatic carotid artery stenosis after CAS were analyzed.Results There was no significant difference in age,gender,smoking,drinking,BMI,DBP,TG,TC,HDL-C,LDL-C,and blood glucose between the HICH group and the control group(P>0.05).The combined rate of coronary heart disease in the HICH group was 27.78%,the rate of collateral failure was 44.44%,the degree of carotid artery stenosis(81.33±4.50)%,and the SBP(137.2±10.7)mmHg were higher than those in the control group.The combined rate of coronary heart disease was 7.41%.The rate of poor collateral circulation was 16.67%,carotid artery stenosis(78.20±4.13)%,SBP(132.0±8.4)mmHg,the difference was statistically significant(P<0.05).Logistic regression analysis shows that poor collateral circulation,increased carotid artery stenosis,and increased SBP measurement after CAS are independent risk factors for HICH in patients with symptomatic severe carotid artery stenosis after CAS(OR value was 1.941,2.257,0.044,respectively,P<0.05).Conclusion Postoperative collateral circulation,increased carotid stenosis,and increased systolic blood pressure after CAS may increase the risk of HICH in patients with symptomatic carotid stenosis after CAS.