症状性颈动脉重度狭窄支架置入术后发生脑高灌注综合征的危险因素分析

Risk factors for cerebral hyperperfusion syndrome after stent placement in symptomatic severe carotid artery stenosis

目的探究症状性颈动脉重度狭窄支架置入术(CAS)后发生脑高灌注综合征(CHS)的危险因素,采取积极的措施进行干预,以降低CHS的发生。方法选取惠州市第一人民医院神经外科及脑血管病科于2016年6月至2022年4月经数字减影血管造影(DSA)诊断且接受CAS治疗的180例症状性颈动脉重度狭窄患者,监测患者动脉平均血流速度(MCAVmean)并以此为依据分为CHS组与非CHS组,单因素和Logistic回归分析其发生CHS的影响因素。结果180例经过CAS治疗的患者中术后18例发生CHS,单因素分析显示:CHS组与非CHS组在糖尿病、新发脑梗死患病率、发病至手术时间、侧支循环代偿分级情况方面,差异有统计学意义(P<0.05);其余因素两组比较,差异无统计学意义(P>0.05)。Logistic回归分析结果显示:糖尿病、新发脑梗死、发病至手术时间、侧支循环代偿分级情况均进入方程,其中糖尿病、新发脑梗死、发病至手术时间为危险因素,侧支循环代偿分级情况为保护因素。结论糖尿病、新发脑梗死及发病至手术时间是CAS术后发生CHS的危险因素,侧支循环代偿分级情况为保护因素,临床上要密切关注患者是否存在危险因素,且全过程给予干预,控制血压、血糖,尽量在发病14 d内完成手术,降低CHS发生的风险。

【Objective】To explore the risk factors of cerebral hyperperfusion syndrome(CHS)after stenting of symptomatic severe carotid artery stenosis(CAS),and to take active measures to intervene to reduce the occurrence of CHS.【Methods】From June 2016 to April 2022,180 patients with symptomatic severe carotid artery stenosis who were diagnosed by DSA and received CAS in the Department of Neurosurgery and Cerebrovascular Diseases were selected,the mean arterial blood flow velocity(MCAVmean)of patients was monitored,according to which the patients were divided into CHS group and non-CHS group,and the influencing factors of CHS were analyzed by univariate and Logistic regression.【Results】Among 180 patients treated with CAS,18 patients developed CHS after operation.Univariate analysis showed that there were statistically significant differences between the two groups in terms of diabetes mellitus,the prevalence of new cerebral infarction,the time from onset to operation,and the grading of collateral circulation compensation(P<0.05),and there was no significant difference in other factors between the two groups(P>0.05).Logistic regression analysis showed that diabetes,new cerebral infarction,time from onset to operation,and collateral circulation compensation grades all entered the equation.Among them,diabetes mellitus,new cerebral infarction,and time from onset to operation are risk factors,and collateral circulation compensation grade is a protective factor.【Conclusion】Diabetes,new cerebral infarction,and time from onset to operation are risk factors for CHS after CAS.The grading of collateral circulation compensation is a protective factor.Clinically,it is necessary to pay close attention to whether there are risk factors in patients,to intervene in the whole process,to control blood pressure and blood sugar,and try to complete the operation within 14 days of onset to reduce the risk of CHS.