药物与支架成形术治疗颅内外血管狭窄的疗效比较  

Comparison of tenting and drug therapy on intracranial and extracranial arterial stenosis

作　　者：刘海平[1] 朱辉[2] 

机构地区：[1]上海市长海医院神经内科,200433 [2] 吉林大学白求恩第一医院神经内科

出　　处：《神经疾病与精神卫生》2017年第1期37-40,共4页Journal of Neuroscience and Mental Health

摘　　要：目的 回顾性探讨症状性脑供血动脉狭窄患者的药物治疗及支架治疗对疾病转归和预后的影响.方法 筛选符合条件的经数字减影血管造影术（DSA）证实脑供血动脉存在中-重度狭窄的患者,分析患者住院期间终点事件（卒中或死亡事件）及出院后至随访日期终点事件（病变血管供血区卒中事件）发生情况.结果 （1）进行住院期间终点事件调查的患者421例,接受经皮腔内血管支架成形术（PTAS）者及单纯药物治疗者分别为256例,165例,两组分别有28例（10.94%）和2例（1.21%）发生了住院期间终点事件,分别有16例（6.25%）和0例发生了严重终点事件（致残或致死性终点事件）,差异均有统计学意义（P〈0.01）.（2）以上患者出院后共随访106例,PTAS联合药物治疗及单纯药物治疗者分别为60例和46例,两组分别有5例（8.33%）和10例（21.74%）发生了出院后至随访日期终点事件（P=0.05）;2例（3.33%）和6例（13.04%）发生了严重终点事件,差异无统计学意义（P〉0.05）.结论 PTAS围手术期并发症较高,但从长远效益来看,较单纯药物治疗,PTAS联合药物治疗可有效防止病变血管供血区卒中事件的发生.Objective To explore the curative effect of drug therapy and percutaneous transluminal angioplasty and stenting （PTAS） on patients with symptomatic cerebral artery stenosis retrospectively. Methods Patients who met the standards of moderate to severe cerebral artery stenosis according to digital subtraction angiography （DSA） were involved. The endpoint events during and beyond hospitalization were analysed.Results （1）Totals of 421 patients, including 256 patients who underwent PTAS and 165 patients who only received drug therapy were included. There were significant differences on primary and serious （disable or fatal） endpoint events between two groups[28（10.94%） vs 2（1.21%）, 16（6.25%）vs 0,P〈0.01]. （2）A total of 60 patients received drug with PTAS and 46 patients received drug therapy only were followed up after hospitalization. There was significant difference on primary endpoint events between two groups[5（8.33%） vs 10（21.74%）, P=0.05]. No significant difference was found in serious endpoint events between[2（3.33%） vs 6（13.04%）,P〉0.05].Conclusions The perioperative complications of PTAS are high. For long-term benefits, drug therapy combined with PTAS can effectively prevent the occurrence of stroke in the territory of pathological artery.

关 键 词：脑供血动脉狭窄 保守治疗 经皮腔内血管支架成形术 

分 类 号：R749.99[医药卫生—神经病学与精神病学]