颈动脉内膜切除术前冠状动脉CT血管成像评估有效性的队列研究

Assessment of coronary CT angiography effectiveness before carotid endarterectomy

目的观察行颈动脉内膜切除术(carotid endarterectomy,CEA)前冠状动脉CT血管造影(CT angiography,CTA)评估对术后缺血性血管并发症的影响。方法纳入2019年1月1日~2021年7月31日中国医科大学附属第一医院神经外科行CEA的老年患者102例。根据是否行冠状动脉CTA评估分为未评估组49例和评估组53例。未评估组无心脏不适症状及病史,且心电图、动态心电图、心脏彩色超声未见异常,并直接行CEA;评估组行冠状动脉CTA检查,根据冠状动脉病变严重情况,43例直接行CEA术,10例行PCI,术后1个月行CEA术。缺血性血管并发症包括术后心肌梗死及脑梗死。观察2组缺血性血管并发症的发生率。结果未评估组与评估组缺血性血管并发症发生率比较,无统计学差异(0%vs 1.9%,P=1.000)。评估组体质量指数、糖化血红蛋白水平明显高于未评估组,差异有统计学意义(P<0.05,P<0.01)。单侧重度颈动脉狭窄伴冠状动脉无重度狭窄、单支重度、双支重度和3支重度狭窄分别为25例(71.4%)、7例(20.0%)、1例(2.9%)、2例(5.7%),双侧重度颈动脉狭窄伴冠状动脉无重度狭窄、单支重度、双支重度和3支重度狭窄分别为13例(72.2%)、2例(11.1%)、1例(5.6%)、2例(11.1%),单侧与双侧颈动脉重度狭窄伴不同冠状动脉重度狭窄比例比较,差异无统计学意义(P=0.681)。结论拟行CEA并疑诊或确诊冠心病患者,术前评估冠状动脉CTA并按现处理流程进行,可控制这部分患者术后缺血性血管并发症。

Objective To study the effect of coronary CT angiography(CTA)before carotid endarterectomy(CEA)on ischemic vascular complications after CEA.Methods One hundred and two≥60 years old patients who underwent CEA in our hospital from 2019-01-01 to 2021-07-31 were dividd into unassessed group(n=49)and assessed group(n=53)according to their symptoms and history of CHD.The patients in unassessed group with normal ECG,dynamic ECG and cardiac color ultrasound tomogram underwent direct CEA.Of the 53 patients in assessed group,43 underwent direct CEA and 10 underwent PCI.The incidence of ischemic vascular complications(myocardial and cerebral infarction)in two groups after CEA was recorded.Results No significant difference was detected in incidence of ischemic vascular complications between the two groups(0.0%vs 1.9%,P=1.000).The BMI and serum HbAlc level were significantly higher in assessed group than in unassessed group(P<0.05,P<0.01).Severe unilateral,1-,2-and 3-branch coronary artery stenosis but no carotid artery stenosis was detected in 25(71.4%),7(20.0%),1(2.9%)and 2(5.7%)patients respectively.Severe bilateral,1-,2-and 3-branch coronary artery stenosis but no carotid artery stenosis was detected in 13(72.2%),2(11.1%),1(5.6%)and 2(11.1%)patients respectively.No significant difference was detected in ratio of unilateral and bilateral severe carotid artery stenosis(P=0.681).Conclusion CEA and assess-ment of CTA before CEA can control the ischemic vascular complications in suspected or estab-lished CHD patients.