颈动脉重度和极重度狭窄的治疗策略和并发症分析

Severe stenosis and more severe stenosis of carotid artery: treatment strategies and complications

目的 :比较重度颈动脉狭窄重度(70%~90%)和极重度(90%以上)病人行颈动脉内膜切除术(carotid endarterectomy, CEA)与颈动脉支架置入术(carotid artery stenting, CAS)的治疗效果和并发症发生情况。方法:回顾性分析2015年1月至2017年12月长海医院收治的463例重度颈动脉狭窄病人接受手术治疗的临床资料。结果:重度颈动脉狭窄的病人202例。CEA组62例与CAS组140例术后再发卒中的差异(3.2%比6.7%)无统计学意义(P=0.181)。CAS组术后再狭窄2.2%,CEA组无再狭窄,差异无统计学意义(P=0.240)。CEA组术后舌偏位、言语不清的发生率4.8%和3.2%,CAS术后无此两种并发症(P=0.009和0.033)。极重度颈动脉狭窄病人261例。CEA组95例和CAS组166例术后再发卒中发生率差异(1.1%比4.5%)无统计学意义(P=0.135),但CAS组较多。CAS术后再狭窄的发生率5.7%,而CEA术后无再狭窄(P=0.017)。CEA组术后发生舌偏位和言语不清4.2%与3.2%,同样CAS组无该并发症(P=0.008和0.021)。结论:CEA与CAS应用于颈动脉重度狭窄病人的治疗效果差异无统计学意义,但CAS术后无神经系统并发症。颈动脉极重度狭窄病人行CEA的治疗效果明显优于CAS。

Objective To compare the efficacy and complications of carotid endarterectomy(CEA)with carotid stenting(CAS)in treatment of patients with severe carotid artery stenosis from 70%to 90%and more severe stenosis>90%.Methods The clinical data of 463 patients with carotid stenosis 70%and more who underwent surgical treatment from January 2015 to December 2017 at Changhai Hospital were retrospectively analyzed.Results There were 202 patients with severe carotid stenosis from 70%to 90%including 62 cases in CEA group and 140 cases in CAS group and no significant difference was present in the incidence of postoperative recurrent stroke between two groups(3.2%vs 6.7%,P=0.181).Restenosis was found 2.2%in CAS group and none in CEA group(P=0.240).Patients with tongue deviation(4.8%)and speech function disorder(3.2%)were found in CEA group and none in CAS group(P=0.009,P=0.033).There were 261 cases with more severe stenosis>90%including 95 cases in CEA group and 166 cases in CAS group.There was no significant difference in the incidence of recurrent stroke between two groups(P=0.135)with 1.1%in CEA group and 4.5%in CAS group respectively.The incidence of restenosis in CAS group was 5.7%and none in CEA group(P=0.017).The occurrence of tongue deviation and speech function disorder in CEA group were 4.2%and 3.2%respectively,and none in CAS group(P=0.008,P=0.021).Conclusions The result of treatment using CEA or CAS was similar for patients with severe carotid stenosis,with no postoperative nervous complication in CAS group.However,the effect of CEA was better than CAS for the patients with more severe carotid stenosis.