球囊扩张直径对症状性颈动脉重度狭窄患者颈动脉支架植入效果的影响

The effect of balloon dilation diameter on the curative result of carotid artery stent implantation in patients with symptomatic severe carotid artery stenosis

目的 观察球囊扩张直径对症状性颈动脉重度狭窄患者支架植入近期效果和安全性的影响.方法 选取2019年2月至2020年3月江南大学附属医院收治的102例症状性颈动脉重度狭窄患者,根据支架植入术中所用预扩张球囊直径分为研究组(5 mm×30 mm球囊,n=51)、对照组(4 mm×30 mm球囊,n=51).记录手术前后两组患者血压、心率、狭窄率、对比剂浓度达峰时间和相对达峰时间.术后1个月随访手术前后狭窄率、狭窄段收缩期峰值流速、舒张末期流速及并发症情况.结果 两组手术均获成功.两组术后收缩压、心率低于术前(均P<0.05),但手术前后收缩压、心率变化值差异无统计学意义(均P>0.05).两组术后对比剂浓度达峰时间、相对达峰时间低于术前(均P<0.05),研究组术后达峰时间、相对达峰时间低于对照组(均P<0.05).两组术后1个月狭窄率、狭窄段收缩期峰值流速、舒张末期流速低于术前(均P<0.05),研究组术后狭窄率、收缩期峰值流速、舒张末期流速低于对照组(均P<0.05).两组术后12个月支架内再狭窄率、总并发症发生率差异无统计学意义(均P>0.05).结论 4 mm、5 mm直径球囊应用于症状性颈动脉重度狭窄患者介入治疗均安全有效,但5 mm球囊预扩张改善重度狭窄的血液流动学效果更佳.

Objective To investigate the effect of balloon dilation diameter on the clinical short-term curative result and safety of carotid artery stent implantation in patients with symptomatic severe carotid artery stenosis.Methods A total of 102 patients with symptomatic carotid artery severe stenosis,who were admitted to the Affiliated Hospital of Jiangnan University of China between February 2019 to March 2020,were collected for this study.According to the predilation balloon diameter used during stenting procedure,the patients were divided into the study group(n=51,using 5 mm by 30 mm balloon)and control group(n=51,using 4 mm by 30 mm balloon).Both the preoperative and postoperative blood pressure,heart rate,carotid stenosis ratio,the time of contrast agent concentration reaching its peak(peak time),and the relative peak time were recorded.One month after treatment,the carotid stenosis ratio,the systolic peak blood flow velocity and the end-diastolic blood flow velocity in the narrowed segment,and the complications were calculated.Results Successful carotid artery stent implantation was accomplished in all patients of both groups.In both groups,the postoperative systolic blood pressure and heart rate were lower than the preoperative ones(P<0.05),although the difference in the change values of systolic blood pressure and heart rate was not statistically significant(P>0.05).In both groups the postoperative peak time and relative peak time of contrast agent concentration were lower than preoperative values(P<0.05),and the postoperative peak time and relative peak time of contrast agent concentration in the study group were lower than those in the control group(P<0.05).In both groups the postoperative one-month carotid stenosis ratio,the systolic peak blood flow velocity and the end-diastolic blood flow velocity in the narrowed segment were lower than the preoperative ones(P<0.05),and the postoperative one-month carotid stenosis ratio,the systolic peak blood flow velocity and the end-diastolic blood flow velocity in the narrowed segment in the study group were lower than those in the control group(P<0.05).No statistically significant differences in the postoperative 12-month in-stent restenosis rate and the total incidence of complications existed between the two groups(P>0.05).Conclusion In treating patients with symptomatic severe carotid artery stenosis with carotid artery stent implantation,both of 5 mm by 30 mm predilation balloon or 4mm by 30mm predilation balloon are clinically safe and effective,but the 5 mm by 30 mm predilation balloon is superior to 4 mm by 30 mm predilation balloon in improving hemodynamics.