分期颈动脉支架植入术及冠状动脉旁路移植术治疗冠心病合并颈动脉狭窄的疗效分析

The efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis

目的 评估分期行颈动脉支架植入术及冠状动脉旁路移植术治疗冠状动脉粥样硬化性心脏病(冠心病)合并颈动脉狭窄的疗效。方法 回顾性分析2019年11月—2021年9月阜外医院收治的冠心病合并颈动脉狭窄患者的临床资料。所有患者均分期行颈动脉支架植入术及冠状动脉旁路移植术。分析围手术期及随访期间心肌梗死、脑梗死和死亡等严重并发症的发生率及危险因素。结果 共纳入58例患者,其中男47例、女11例,手术年龄52~77(64.2±5.6)岁。冠状动脉旁路移植术术前无严重并发症发生,术后早期发生心肌梗死1例、脑梗死1例、死亡1例,术后早期严重并发症发生率为5.2%。平均随访时间为18.3个月,随访期间发生脑梗死1例、死亡2例,整体严重并发症发生率为10.3%。Kaplan-Meier生存曲线分析显示,有症状性颈动脉狭窄(log-rank,P=0.037)和置入闭环支架(log-rank,P=0.030)患者术后发生缺血性脑血管事件的风险较高;有既往陈旧性脑梗死的患者,术后发生严重并发症的风险较高(log-rank,P=0.044)。结论 分期行颈动脉支架植入术及冠状动脉旁路移植术治疗冠心病合并颈动脉狭窄安全可行。

Objective To evaluate the efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis.Methods The clinical data of patients with coronary heart disease and carotid stenosis treated in Fuwai Hospital from November 2019 to September2021 were retrospectively analyzed.All patients underwent staged carotid artery stenting and coronary artery bypass grafting.The incidence and risk factors of severe complications such as myocardial infarction,cerebral infarction and death during the perioperative period and follow-up were analyzed.Results A total of 58 patients were enrolled,including 47 males and 11 females with an average age of 52-77(64.2±5.6) years.No complications occurred before coronary artery bypass grafting.There was 1 myocardial infarction,1 cerebral infarction and 1 death after the coronary artery bypass grafting.The early complication rate was 5.2%.During the follow-up of 18.3 months,1 cerebral infarction and 2 deaths occurred,and the overall complication rate was 10.3%.According to Kaplan-Meier survival curve analysis,patients with symptomatic carotid stenosis(log-rank,P=0.037) and placement of close-cell(log-rank,P=0.030) had a higher risk of postoperative ischemic cerebrovascular event,and patients with previous cerebral infarction had a higher risk of postoperative severe complications(log-rank,P=0.044).Conclusion Staged carotid artery stenting and coronary artery bypass grafting is safe and feasible for the treatment of coronary heart disease complicated with carotid stenosis.