| 赵守财,杨倩,吴雪松,等.血管内再通术治疗颈动脉粥样硬化性闭塞性病变与颈动脉狭窄支架置入术的疗效比较[J].安徽医药,2016,20(11):2055-2060. |
| 血管内再通术治疗颈动脉粥样硬化性闭塞性病变与颈动脉狭窄支架置入术的疗效比较 |
| A comparative study between endovascular recanalizing in treating atherosclerotic internal carotid artery occlusion and stenting for carotid artery stenosis |
| 投稿时间：2016-08-23 |
| DOI： |
| 中文关键词: 颈动脉狭窄 颈动脉闭塞 血管内再通术 支架植入术 缺血性卒中 不良事件 |
| 英文关键词: carotid artery stenosis carotid artery occlusion endovascular recanalization stenting ischemia stroke adverse incident |
| 基金项目:国家自然科学基金资助项目(81171110;81371295) |
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| 中文摘要: |
| 目的 比较颈动脉闭塞血管内再通术和颈动脉狭窄支架置入术(CAS)患者手术成功率和围手术期及近期不良事件,探讨颈动脉闭塞血管内再通术的疗效。方法 回顾性分析接受颈动脉CAS的症状性颈动脉狭窄和颈动脉闭塞再通术患者的人口统计学资料、危险因素及颈动脉狭窄CAS术和闭塞再通术中及术后相关因素、围手术期及随访结果。结果 共有54例颈动脉狭窄和17例颈动脉闭塞患者,54例颈动脉狭窄患者均成功置入支架而纳入狭窄组；17例颈动脉闭塞患者,再通失败2例,成功再通并置入支架患者15例并纳入闭塞组。狭窄组术后残余狭窄率为0～30％,平均为13％～18％,技术成功率为100%。闭塞组术后残余狭窄率为0～30％,平均为17％～22％,但是再通技术成功率为88.2%。两组病例中狭窄部位、术后心动过缓、术后低血压及高灌注综合征差异无统计学意义(P＞0.05),而支架长度、球囊预扩、保护装置的应用与否、支架长度及手术时间差异有统计学意义(P＜0.01)。多元Logistic回归分析表明闭塞组不良事件发生率与支架长度、保护装置的应用与否、支架长度及手术时间等差异无统计学意义。围手术期并发症:狭窄组小中风2例,大中风0例；闭塞组小中风1例、大中风1例。总体不良事件发生率为5.8%,其中狭窄组为3.7%,闭塞组为13.3%。但颈动脉闭塞组与狭窄组比较差异无统计学意义(P﹥0.05)；1月后总临床成功率为98.6%。2月至1.5年随访,无支架内再狭窄及不良事件发生。结论 颈内动脉闭塞再通术是安全可行的,患者耐受性较好,但由于颈动脉闭塞病例数较少,技术成功率及并发症发生率可能过高,潜在的严重并发症可能被低估,今后还需进一步的研究。 |
| 英文摘要: |
| Objective To investigate the efficacy of endovascular recanalizing of carotid artery occlusion in patients with atherosclerotic internal carotid artery occlusion.Methods The clinical data of endovascular stenting therapy applied in patients with atherosclerotic internal carotid artery stenosis and endovascular recanalization of occlusion applied in patients with carotid artery occlusion were analyzed retrospectively,including demographic characteristics,vascular risk factors,intraoperative and postoperative factors,periopration and follow-up results.Results A total of 54 patients with atherosclerotic internal carotid artery stenosis received stenting therapy and were included in group of stenosis;and in 17 patients who received therapy of endovascular recanalization of occlusion,2 patients failed to recanalize,while another 15 patients succeeded and were included in group of occlusion.Rate of residual stenosis,average rate and technical success rate in stenosis group and occlusion group were 0～30％ vs 0～30％,13％～18％ vs 17％～22％,and 100% vs 88.2%,respectively.There were no statistically significant differences in stenosis site,postoperative bradycardia and hypotension,hypertransfusion(P＞0.05),but there were statistically significant differences in length of stents,predilation of balloon,protector application and operation time between two groups(P＜0.01).Logistic multivariate regression analysis showed that there were no significant correlation between the incidence of adverse events with length of stents,distal protector application and operation time(P＞0.05).As for perioperative complications,there were 2 cases of minor stroke and 0 case of major stroke in stenosis group and there were 1 minor stroke and 1 major stroke in occlusion group.The overall adverse incidence was 5.8%,3.7% in stenosis group and 13.3% in occlusion group.There was no statistically significant difference between two groups(P＞0.05).One month after the surgery,the overall clinic success rate was 98.6%.Two month to one-and-a-half-year follow-up results showed that there was no adverse event and restenosis.Conclusions Endovascular recanalization of carotid artery occlusion is feasible and well-tolerated in patients with subacute or chronic total occlusion of the internal carotid artery.But the number of cases included in the study is small,so the technical success rate and adverse rate might be overestimated.Further studies are required to elucidate fully the risks and the benefits of this procedure. |
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