症状性颅外颈动脉狭窄的血管内支架和药物治疗的临床疗效研究  

Clinical study of carotid artery stenting and medical therapy in patients with symptomatic extracranial carotid artery stenosis

作　　者：佘家贵[1] 刘建民[1] 邓本强[1] 洪波[1] 许奕[1] 张永巍[1] 黄清海[1] 张珑[1] 

机构地区：[1]上海第二军医大学长海医院神经外科,200433

出　　处：《介入放射学杂志》2004年第S1期152-155,共4页Journal of Interventional Radiology

摘　　要：目的　对比分析症状性颅外颈动脉狭窄的血管内支架和单纯药物治疗的疗效 ,评价两种治疗方法的有效性和安全性。方法　 2 0 0 1年到 2 0 0 3年我科门诊及病房治疗的症状性颅外颈动脉狭窄2 6 5例 ,其中支架治疗组 16 0例 ,单纯药物治疗组 10 5例。结果　颈动脉支架成形术 (CAS)手术的技术成功率 10 0 % ,血管狭窄由术前平均 79.5 %± 14 .6 %降至术后平均 11.2 %± 7.8% (P <0 .0 1) ,血管直径由术前 1.5± 0 .6mm恢复至 4 .1± 0 .4mm。治疗 30d内支架组和药物组各有 1例大卒中 (0 .6 3%、0 .95 % ,P >0 .0 5 ) ,药物组死亡 1例 (0 .95 % ) ,支架组无死亡。平均随访 13.5个月 ,支架组无死亡 ,同侧卒中 1例(0 .6 3% ) ,总的卒中和死亡 2例 (1.2 5 % ) ,药物组同侧卒中 4例 (3.81% ) ,死亡 1例 (0 .95 % ) ,总的卒中和死亡 5例 (4 .76 % )。支架组再狭窄 1例 (0 .6 3% ) ,因患者临床没有脑缺血症状 ,未进行再次治疗。结论　颈动脉支架成形术是治疗症状性颅外颈动脉狭窄和预防卒中安全而有效的方法 ,其围手术期总的卒中和死亡率低 ,1年随访卒中复发率和再狭窄率低 ,较单纯药物疗效更好。Objective To assess the efficacy and safety of carotid artery stenting and medical therapy in patients with symptomatic extracranial carotid stenosis ,we comparisoned and analysised clinical outcome of the two methods.Methods A retrospective analysis was conducted of a total of 265 patients with symptomatic extracranial carotid stenosis who had full follow-up data in our hospital from 2001 to 2003. 160 patients were treated by means of endovascular stent , 105 patients were received aspirin and ticlopidine. Results There was a technical success of 100% with 160 carotid arteries treated. The average stenosis rate was reduced from( 79.5 ±14.6)% before treatment to ( 11.2± 7.8)% after stent-assisted angioplasty. The diameter of carotid artery was increased from ( 1.5 ±0.6)mm to ( 4.1 ±0.4)mm (P< 0.01). The number of major stroke was same in two groups (n=1), the difference was not statistically significant ( 0.63% versus 0.95%; P >0.05).There was 1 death in medical group,no deaths occurred in stent group. During the follow-up (mean 13.5 months) period the ipsilateral stroke rate was 0.63%(n=1),and the total stroke and death was 1.25%(n=2) in stent group. The ipsilateral stroke rate was 3.81%(n=4),and the total stroke and death was 4.76%(n=5) in medical group during the follow-up period.Conclusions Carotid angioplasty and stenting is more feasible and safe for the treatment of symptomatic extracranial carotid stenosis than medical therapy,the total perioperative stroke and mortality rate is low. At long-term follow-up,the recurrent stroke and restenosis rate is low.

关 键 词：血管成形术 颈动脉狭窄 支架 阿司匹林 噻氯匹定 随访 

分 类 号：R743.3[医药卫生—神经病学与精神病学]