支架成形术治疗高龄颅外段颈动脉狭窄相关危险因素探讨  

Risk factors in carotid angioplasty and stenting for extracranial carotid stenosis of elderly patients

作　　者：徐军[1] 王君[1] 李宝民[1] 李生[1] 曹向宇[1] 刘新峰[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华外科杂志》2012年第6期534-538,共5页Chinese Journal of Surgery

摘　　要：目的探讨颈动脉血管成形支架置入术（CAS）治疗高龄颅外段颈动脉狭窄的危险因素和安全性，总结其对高龄患者的适应证选择和对并发症的预防及处理。方法回顾性分析2001年6月到2010年12月入院接受CAS治疗并具备完整治疗和随访资料的60例高龄（t〉75岁）患者资料，其中男性57例，女性3例；年龄75～93岁，平均年龄78．8岁。病程1—6个月，平均2．5个月。按术后狭窄的纠正情况、NIHSS评分、术后早期不良事件的发生情况、术后30d终点事件以及随访状况对CAS预后情况进行总结。采用x2检验进行统计分析。结果狭窄程度由术前的平均81％±17％减小至术后的18％±9％；NIHSS评分由术前的（22±8）分，降至术后的（10±4）分；随访3个月至3年，平均随访1年，CAS无手术相关性死亡发生，发生手术侧卒中1例（1．7％），发生术后再狭窄（〉150％）2例（3．3％）。糖尿病（x2=23．96，P〈0．01）、心功能不全（x2=6．446，P〈0．05）等对术后早期并发症的发生有显著性影响。结论CAS治疗高龄患者颅外段颈动脉狭窄效果较好；糖尿病和心功能不全等危险因素更易增加术后发生不良事件的风险。Objectives To evaluate the risk factors and safety of carotid angioplasty and stenting （CAS） for extracranial carotid stenosis in elderly patients and summarize CAS on the indication of elderly patients and the prevention of complications. Methods The population characteristics, clinical features and vascular data of 60 elderly patients （ ≥ 75 years） treated between June 2001 and December 2010 were retrospectively analyzed. There were 57 male and 3 female. The median age of the patients was 78. 8 years （range, 75-93 years ）. The mean case history was 2. 5 months with a range of 1 to 6 months. To summarize the prognosis of CAS according to the reduction of stenosis, NIHSS score, the incidence of early postoperative,30 days adverse events and the follow-up status. Using X2 test as the statistical method. Results The mean stenosis was reduced from 81% ± 17% preoperative to 18% ±9% postoperative. NIHSS score was reduced from preoperative 22 ± 8 to postoperative 10± 4. The average follow-up period was 1.5 years （range from 3 months to 3 years） , and the results showed no procedure-related death occurred. Ipsilateral stroke oecured in 1 case （ 1.7% ） and restenosis （ ≥50% ） occurred in 2 patients （3.3%）. Diabetes （X2 = 23.96, P 〈 0. 01 ） and cardiac insufficiency （ X2 = 6. 446, P 〈 0. 05 ） had a respectively significant impact on the incidence of early postoperative complications. Conclusions CAS can be effective in restoring carotid artery stenosis of elderly patients and preventing the occurrence of stroke. The eld, diabetes, cardiac insufficiency are more likely to increase the postoperative risk of adverse events.

关 键 词：颈动脉狭窄 支架 血管成形术 老年人 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]