老年高危颈动脉狭窄患者支架治疗的临床效果

Clinical outcomes of carotid artery stenting in high-risk old patients

目的 观察老年高危颈动脉狭窄患者接受支架治疗的临床效果。方法 回顾总结1998年 3月至 1999年 3月入院的 2 0名有症状的并接受了颈动脉支架治疗的颈动脉狭窄患者的临床资料 ,患者平均年龄 70岁 ,其中 18人 (90 % )同时合并高血压病、高脂血症及冠状动脉粥样硬化性心脏病 ,7人 (35 % )合并 2型糖尿病 ,15人 (75 % )合并周围动脉阻塞性疾病。选择性颈动脉血管造影显示病变共 2 6个 ,其中右 左颈总动脉病变 7个、右 左颈内动脉 19个 ,管腔狭窄均≥ 70 % ,病变平均长为 (14 5± 9 2 )mm。结果 支架治疗后血管造影显示成功率为 10 0 % (n =2 6 ) ,基础靶病变的最小腔内径 (MLD)为 (1 9± 1 2 )mm ,支架后MLD上升至 (5 9± 1 4 )mm ,与基础MLD相比P <0 0 0 0 1[正常的参照血管直径 =(5 3± 1 2 )mm]。直径狭窄百分比由基础 70 2 %± 13 3%降至 - 1 7%± 10 5 %(P <0 0 0 0 1) ,球囊扩张的最大平均压为 12 7大气压 ,每个靶病变平均置入支架 (1 5± 0 7)个。 19名病人临床症状明显改善 ,临床成功率为 95 % (19 2 0 ) ,1名病人 (5 % )在术后第 6天死于腹膜后血肿。85 %病人 (17名 )平均随访 (5± 2 )个月 (1～ 10个月 ) ,其中 82 4 % (14名 )病人无症状存活 。

Objective To observe the clinical results of carotid artery stenting in symptomatic high-risk old patients. Methods Twenty patients who were hospitalized between 1998 and 1999 with symptomatic carotid artery stenosis were studied,retrospectively. Mean age of the patients was 70 years. 90% of patients complicated with hypertension,hyperlipidemia and severe coronary artery diseases,35% with diabetes,and 75% with peripheral artery obstructive disease. Carotid artery angiogram showed 26 lesions,7 located at right /left common carotid artery,and 19 at right/left internal carotid artery. The percentage of lumen stenosis in all lesions was greater than 70%. The mean lesion length was (14.5±9.2) mm. Results Acute procedural success rate confirmed by angiogram was achieved in all patients (100%). The minimal lumen diameter was increased from (1.9±1.2) mm at baseline to (5.9±1.4) mm post stenting ( P <0.000?1). The lumen stenosis was decreased from 70.2%±13.3% to -1.7%±10.5% ( P <0.000?1). The mean balloon dilatation pressure was 12.7 ATM,and the mean number of stents implanted in each target lesion was 1.5±0.7. Clinical symptoms were improved significantly in 19 patients (95%),but one patient died from retroperitoneal hematoma 6 days after stenting. 85% of patients were followed up from one to ten months. 82.4% of patients were asymptomatie and survived event-free. One patient had in-stent restenosis 6 months lator and received the procedure of balloon revascularization. Three patients sacrified from cardiac attack at the end of 6,8,and 10 months of the follow-up,respectively and we did not considered which case was related to the procedure of carotid stenting. Conclusion Implantation of stenting was a safe and effective adjunctive method for treatment of symptomatic high-risk old patients with significant carotid artery stenosis. The acute success rate was high and the results of the mean six months follow-up were optimal.