颈动脉支架置入术后脑高灌注综合征的危险因素分析及预防措施

Risk Factors and Preventive Measures of Cerebral Hyperperfusion Syndrome After Carotid Angioplasty and Stenting

目的研究颈动脉支架置入术并发脑高灌注综合征的危险因素,探讨可能的预防措施。方法回顾性分析209例颈动脉狭窄并行颈动脉支架置入术患者的临床资料。按照是否发生脑高灌注综合征分为高灌注综合征组和非高灌注综合征组。搜集两组患者相关临床资料,采用单因素分析有统计学差异的因素,进一步行Logistic回归分析,绘制ROC曲线,计算曲线下面积(AUC)。结果209例研究对象中脑高灌注综合征发生率为6.2%(13/209),单因素结果分析显示两组间在手术时间窗、术后血压、术前狭窄率、侧支循环代偿能力差方面差异有统计学意义(P<0.05)。进一步行多因素Logistic回归分析显示手术时间窗<2周、术后高血压、侧支循环差、术前狭窄率均为脑高灌注综合征的独立危险因素。ROC曲线结果显示,计算手术时间窗<2周、术后高血压、侧支循环差、术前狭窄率预测脑高灌注综合征的AUC分别为0.686、0.682、0.772、0.682。四者均有良好的预测价值。结论手术时间窗<2周、术后高血压、侧支循环差、术前狭窄率是颈动脉支架置入术后并发脑高灌注综合征的独立危险因素,早期识别及预防危险因素具有重要意义。

Objective To explore the influencing factors and prophylactic measures for cerebral hyperperfusion syndrome after carotid artery stenting.Methods We analyzed 209 patients data with carotid artery stenosis who underwent CAS.All patients were divided into two groups based on upon the occurrence of hyperperfusion syndrome.The clinical results were collected.We evaluated multiple predictive factors for the incidence of cerebral hyperperfusion syndrome using univariate and binary Logistic regression analysis and receiver operating characteristics curves were used to identify independent predictors of cerebral hyperperfusion syndrome after carotid artery stenting.Results The incidence of cerebral hyperperfusion syndrome in 209 patients was 6.2%(13/209),the incidence of cerebral hemorrhage related to cerebral hyperperfusion syndrome was 2.4%(5/209),the incidence of headache was 46.2%(6/13),and the incidence of epilepsy was 23.1%(3/13).The incidence of neurological impairment was 23.1%(3/13),and the incidence of consciousness disturbance was 7.6%(1/13).Single-factor analysis showed that there were statistically significant differences between the two groups in terms of operation time window,postoperative blood pressure,preoperative stenosis rate,and poor compensatory ability of collateral circulation(P<0.05).Multivariate Logistic regression analysis showed that the operative time window<2 weeks,postoperative hypertension,poor collateral circulation,preoperative stenosis rate were independent risk factors for cerebral hyperperfusion syndrome.ROC curve was showed that the area under the curve(AUC)for predicting cerebral hyperperfusion syndrome was 0.686,0.682,0.772 and 0.682,respectively,when the operative time window<2 weeks,postoperative hypertension,poor collateral circulation and preoperative stenosis rate were calculated.Conclusion The operative time window<2 weeks,postoperative hypertension,poor collateral circulation and preoperative stenosis rate are the independent risk factors of cerebral hyperperfusion syndrome after carotid artery stenting,and early identification and prevention of risk factors is of great significance.