颈动脉支架置入术在合并无症状颈动脉重度狭窄的冠状动脉旁路移植术中的应用

Carotid stenting in coronary artery bypass grafting patients with asymptomatic severe carotid artery stenosis

目的对比分析颈动脉支架置入术(carotid artery stenting,CAS)联合冠状动脉旁路移植术(coronary artery bypass grafting,CABG)和单纯CABG两种术式治疗冠心病合并无症状重度颈动脉狭窄患者的围手术期情况及随访资料,评估CAS-CABG联合手术的安全性和有效性。方法回顾性分析2018年1月至2022年12月在北京安贞医院、北京朝阳医院、北京天坛医院行CABG治疗的700例冠心病合并无症状颈动脉重度狭窄患者的病历资料。根据是否进行CAS处理,分为CAS-CABG组(116例)和单纯CABG组(584例)。CAS-CABG组平均(64.8±7.3)岁,均仅行单侧CAS手术;单纯CABG组平均(65.5±7.6)岁。比较两组患者术后30天及中位24个月随访的主要结果。应用logistic回归法行单因素和多因素分析。结果CAS-CABG组患者术后早期卒中发生率显著降低(2.6%对9.1%,P=0.02),CAS联合CABG手术并未增加随访期间病死率和不良事件发生率。亚组分析发现,两种术式治疗无症状单侧颈动脉重度狭窄的卒中发生率差异无统计学意义,高龄、房颤史和卒中史是无症状单侧颈动脉重度狭窄CABG术后早期卒中的独立危险因素。结论CAS联合CABG治疗冠心病合并无症状颈动脉狭窄安全有效,可降低患者术后早期卒中发生率。应合理筛选合并无症状颈动脉狭窄的CABG患者,进行预防性CAS以降低此类患者术后卒中风险。

Objective To evaluate the perioperative and follow-up data of carotid artery stenting(CAS)+coronary artery bypass grafting(CABG)and CABG alone,and to assess the safety and efficacy of CAS in the treatment of severe stenosis of the carotid artery in combination with asymptomatic carotid artery stenosis.Methods A retrospective analysis of 700 CABG patients combined asymptomatic carotid artery severe stenosis at Beijing Anzhen Hospital,Beijing Chaoyang Hospital,and Beijing Tiantan Hospital from January 2018 to December 2022 was performed.According to whether or not underwent CAS treatment,they were divided into the CAS-CABG group(116 cases)and the CABG-only group(584 cases).The mean age of the CAS-CABG group was(64.8±7.3)years,and all of them underwent unilateral CAS surgery only;the mean age of the CABG only group was(65.5±7.6)years.The main results of the patients in the two groups were compared at 30 days after the operation and follow-up period.Results The early postoperative stroke rate was significantly lower in the CAS-CABG group(2.6%vs.9.1%,P=0.02),while the combined procedure did not increase the rates of mortality and adverse events during follow-up.Subgroup analysis revealed that there was no significant difference in stroke rates between the two procedures for asymptomatic unilateral carotid artery stenosis,advanced age,history of atrial fibrillation,and history of stroke were independent risk factors for early stroke in CABG for asymptomatic unilateral carotid artery stenosis.Conclusion CAS-CABG is safe and effective in the treatment of coronary artery disease combined with asymptomatic carotid artery stenosis,and can reduce the incidence of early postoperative stroke in patients.CABG patients with asymptomatic carotid stenosis should be rationally screened for prophylactic CAS to reduce the risk of postoperative stroke in these patients.