双侧颈动脉狭窄外科治疗的单中心15年经验

Surgical treatment in patients with bilateral carotid artery stenosis:A single-center experience of 15 years

目的研究双侧颈动脉狭窄患者行颈动脉内膜剥脱术(carotid endarterectomy,CEA)和颈动脉支架植入术(carotid artery stenting,CAS)的15年疗效和长期获益。方法回顾性收集2008~2023年在首都医科大学附属北京安贞医院行CEA和CAS治疗的234例双侧颈动脉狭窄患者的临床资料,分析基线数据、围手术期严重并发症、死亡情况以及术后长期的全因死亡、脑卒中、术侧颈动脉再狭窄发生率。结果118例行双侧手术治疗。53.85%的患者首次手术为右侧,65.81%首次治疗采用CAS。双侧手术间隔时间2周至11年,中位间隔时间3个月。首次手术后围手术期死亡患者2例,二次手术后围手术期死亡患者1例。术后发生局部皮下血肿18例,高灌注综合征7例,新发缺血性脑卒中19例。206例患者得到随访,随访周期为1~15年,中位随访时间28个月,全因死亡患者28例,其中9例因卒中死亡,6例因脑出血死亡。随访期间发生心梗13例,脑出血10例,卒中31例,术侧再狭窄22例。CAS和CEA患者死亡、脑卒中、再狭窄事件发生情况的差异均无统计学意义(P>0.05)。结论本中心通过合理的手术方案选择和精细的围手术期管理,对双侧颈动脉狭窄的治疗取得了良好的效果和长期获益。

Objective To study the 15-year efficacy and long-term benefits of carotid endarterectomy(CEA)and carotid artery stenting(CAS)in patients with bilateral carotid stenosis.Methods The clinical data of 234 patients with bilateral carotid stenosis who underwent CEA and CAS at Beijing Anzhen Hospital,Capital Medical University from 2008 to 2023 were collected retrospectively.The baseline data,perioperative serious complications,deaths,and long-term all-cause mortality,stroke and postoperative carotid artery restenosis incidence were analyzed.Results 118 patients underwent bilateral surgical treatment.53.85%of patients had their first surgery on the right side,and 65.81%underwent CAS for the first surgery.The interval between bilateral surgeries ranged from 2 weeks to 11 years,with a median interval of 3 months.There were 2 perioperative deaths after the first operation and 1 perioperative death after the second operation.Postoperative local subcutaneous hematoma occurred in 18 cases,hyperperfusion syndrome in 7 cases and ischemic stroke in 19 cases.206 patients were followed up,with a follow-up period of 1 to 15 years,and the median time was 28 months.There were 28 patients who died from all causes,including 9 deaths due to stroke and 6 deaths due to cerebral hemorrhage.During the follow-up period,13 cases of myocardial infarction,10 cases of cerebral hemorrhage,31 cases of stroke,and 22 cases of restenosis on the operated side occurred.There were no statistically significant differences in the occurrence of death,stroke and restenosis events between CAS and CEA patients(P>0.05).Conclusion Our center has achieved good results and long-term benefits in the treatment of bilateral carotid stenosis through reasonable surgical program selection and meticulous perioperative management.