脑侧支循环对颈动脉支架成形术治疗症状性颈动脉狭窄患者安全性及疗效的影响

Effects of cerebral collateral circulation on the safety and efficacy in patients with symptomatic carotid stenosis treated with carotid artery stenting

目的评价脑侧支循环对颈动脉支架成形术(CAS)治疗症状性颈内动脉狭窄患者安全性及疗效的影响。方法选取2018年6月至2020年6月江门市中心医院收治的症状性颈动脉狭窄患者103例作为研究对象,根据脑侧支循环情况分为脑侧支循环良好组(n=49)和脑侧支循环不良组(n=54)。两组患者均行颈动脉支架成形术,比较两组围手术期并发症、术后1年脑梗死复发率;比较两组术后1周、6个月及1年NIHSS评分、Barthel指数及mRS评分。结果脑侧支循环不良组围手术期并发症发生率为3.70%,脑侧支循环良好组并发症发生率为2.04%,差异无统计学意义(P>0.05);脑侧支循环不良组1年脑梗死复发率(16.67%)高于脑侧支循环良好组(6.12%),差异有统计学意义(P<0.05);脑侧支循环良好组术后1年NIHSS评分变化高于脑侧支循环不良组,差异有统计学意义(P<0.05);脑侧支循环良好组术后1年mRS评分低于脑侧支循环不良组,差异有统计学意义(P<0.05);脑侧支循环良好组术后6个月及1年Barthel指数均高于脑侧支循环不良组,差异有统计学意义(P<0.05)。结论良好的脑侧支循环,可以降低颈动脉支架成形术治疗症状性颈动脉狭窄患者的脑梗死复发率,提高患者远期临床预后。

Objective To evaluate the effects of cerebral collateral circulation(CCC)on the safety and efficacy in patients with symptomatic carotid stenosis treated with carotid artery stenting(CAS).Methods A total of 103 patients with symptomatic carotid stenosis admitted to Jiangmen Central Hospital from June 2018 to June 2020 were selected as study subjects and divided into the group with good CCC(n=49)and the group with poor CCC(n=54)according to the status of CCC.Both groups of patients underwent CAS.The incidence of perioperative complications and the relapse rate of cerebral infarction at 1 year after surgery were compared between the two groups.In addition,the National Institute of Health Stroke Scale(NIHSS)score,Barthel index and Modified Rankin Scale(mRS)score at 1 week,6 months and 1 year after surgery were also compared between the two groups.Results The incidence of perioperative complications was 3.70%in the group with poor CCC and 2.04%in the group with good CCC,with no statistically significant difference(P>0.05).The relapse rate of cerebral infarction at 1 year after surgery was higher in the group with poor CCC(16.67%)than in the group with good CCC(6.12%),with statistically significant difference(P<0.05).The changing amplitude of NIHSS scores at 1 year after surgery was higher in the group with good CCC than in the group with poor CCC,with statistically significant difference(P<0.05).The mRS scores at 1 year after surgery were lower in the group with good CCC than in the group with poor CCC,with statistically significant difference(P<0.05).The Barthel indexes at 6 months and 1 year after surgery were higher in the group with good CCC than in the group with poor CCC,with statistically significant differences(P<0.05).Conclusion Good CCC can reduce the relapse rate of cerebral infarction in patients with symptomatic carotid stenosis treated with CAS and improve the long-term clinical prognosis of patients.