颈动脉支架术治疗颈动脉狭窄合并冠心病患者的可行性和安全性  

Safety and feasibility of carotid artery stenting in patients with coexisting carotid and coronary artery disease

作　　者：董徽[1] 蒋雄京[1] 关婷[1] 张慧敏[1] 腾思勇[1] 彭猛[1] 吉薇[1] 杨跃进[1] 高润霖[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院心内科 ,100037

出　　处：《中华心血管病杂志》2013年第7期577-582,共6页Chinese Journal of Cardiology

摘　　要：目的评估颈动脉支架术治疗颈动脉狭窄合并冠心病患者的可行性和安全性。方法入选2005年1月至2010年6月在阜外心血管病医院接受颈动脉支架术的237例颈动脉狭窄合并冠心病患者，对其临床资料进行回顾性分析。颈动脉支架术的指征为颈动脉管腔直径减少〉60％（症状性颈动脉狭窄）或〉80％（无症状性颈动脉狭窄），且颈动脉解剖适合行支架术。观察支架术后30d卒中、死亡和心肌梗死的发生情况。结果患者年龄（66．1±7．7）岁，男性189例（79．7％）。不稳定性心绞痛87例（36．7％），近期（〈30d）心肌梗死82例（34．6％）。颈动脉支架术的技术成功率为99．2％（235／237），栓塞防护装置的使用率为99．6％（234／235）。36例（15．2％）患者同时行双侧颈动脉支架术，79例（33．3％）患者同时行其他外周动脉的介入治疗。颈动脉支架术后30d，127例（53．6％）患者进行了冠状动脉血运重建，包括118例（49．8％）冠状动脉旁路移植术，9例（3．8％）冠状动脉支架术。支架术后30d，大卒中、小卒中、死亡和心肌梗死的发生率分别为2．1％（5／237）、3．0％（7／237）、0．4％（1／237）和0．4％（1／237）。结论颈动脉狭窄合并冠心病患者行颈动脉支架术安全、可行，围手术期并发症发生率低。Objective To evaluate the safety and feasibility of carotid artery stenting （CAS for treating patients with coexisting carotid and coronary artery disease. Methods The clinical data of 237 consecutive patients [ （66. 1 ± 7.7） years old, 79.7% male] with coexisting carotid and coronary artery disease undergoing CAS in Fuwai hospital from January 2005 to June 2010. The patients were analyzed retrospectively. Indication for CAS was defined as carotid artery diameter reduction of 〉 60% （symptomatic） or 〉 80% （ asymptomatic ） with suitable carotid artery anatomy for stenting. Thirty-day rates of stroke, death and myocardial infarction after CAS were assessed. Results All patients suffered from coronary artery disease, of whom 87 （36. 7% ） had unstable angina pectoris and 82 （34.6%） had recent myocardial infarction （ 〈 30 days）. The procedural success rate of CAS was 99.2 % （ 235/237 ）. Cerebral protection devices were used in 234 patients （99.6%）. Among them, 36 （ 15.2% ） patients received simultaneous bilateral CAS and 79 （33.3%） patients underwent simultaneous percutaneous intervention of other non- coronary arteries. Within 30 days after CAS, 127 （53.6%） patients underwent coronary revascularization, including 118 （49. 6%） coronary artery bypass grafting and 9 （3.8%） percntaneous coronary intervention. The rate of major stroke, minor stroke, death and myocardial infarction from time of CAS to 30 days was 2. 1% （ 5/237 ） , 3.0% （ 7/237 ） , 0. 4% （ 1/237 ） and 0. 4% （ 1/237 ） respectively. Conclusion Data from this study indicate that CAS is safe and feasible for treating patients with coexisting carotid and coronary artery disease with a low incidence of periprocedural complication rate.

关 键 词：颈动脉狭窄 冠状动脉疾病 支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.4[医药卫生—临床医学]