CABG术前颈动脉重度狭窄亚满意血管成形术有效性和安全性分析  

Effectiveness and safety of submaximal angioplasty and stenting for patients with severe carotid artery stenosis before CABG

作　　者：郭旭[1] 范承哲[1] 马玉栋 王力锋[1] 张楠[1] 王洋[1] 于蕾[1] 何晓芬[1] 杨新健 Guo Xu;Fan Chengzhe;Ma Yudong;Wang Lifeng;Zhang Nan;Wang Yang;Yu Lei;He Xiaofen;Yang Xinjian(Department of Neurointervention,Beijing Anzhen Hospital,Capital Medical University,Beijng 100029,China;Department of Neurointervention,Beijing Tiantan Hospital,Capital Medical University,Beijng 100070,China)

机构地区：[1]首都医科大学附属北京安贞医院神经介入科,100029 [2]首都医科大学附属北京天坛医院神经介入中心,100070

出　　处：《中华胸心血管外科杂志》2021年第4期250-254,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨分析CABG术前症状性颈动脉重度狭窄的亚满意球囊扩张和小直径支架置入术的有效性和安全性。方法回顾性纳入2016年1月至2019年12月期间首都医科大学附属北京安贞医院神经介入科连续30例冠状动脉粥样硬化性心脏病(冠心病)左主干或冠状动脉三支病变合并颈内动脉重度狭窄(≥70%)患者,行小球囊亚满意扩张及小直径支架置入术,收集患者一般资料、临床和影像资料等。30例中冠心病左主干病变6例,三支病变24例。既往同侧颈动脉狭窄伴脑梗塞24例,短暂性脑缺血发作6例。技术成功定义为颈内动脉支架成形术后前向血流mTICI3级,且残余狭窄<50%。围手术期并发症定义为颈动脉支架置入术和CABG术后30天内出现急性缺血性或出血性卒中、急性冠状动脉综合征和全因性死亡。亚满意成形定义为球囊扩张和支架成形至靶血管管腔直径的80%。结果全组手术成功29例(96.7%,29/30)。出现围手术期并发症1例,为颈动脉支架置入术后急性冠状动脉综合征。术后随访30天,短暂性脑缺血发作和脑梗塞各1例,无心脏相关并发症。结论CABG术前接受亚满意球囊扩张和小直径支架置入术安全可行,可减少颈动脉狭窄介入术中迷走反射所致急性冠状动脉综合征不良事件和CABG围手术期低灌注致急性缺血性卒中发生。Objective To investigate the feasibility and safety of submaximal balloon dilation and to perform small-diameter stent for symptomatic carotid artery severely stenosis before coronary artery bypass grafting(CABG).Methods From January 2016 to December 2019,30 patients of the Department of Neurointervention in Beijing Anzhen Hospital with symptomatic carotid artery stenosis(≥70%)and the left main trunk or triple-vessel of coronary artery disease were analyzed retrospectively.General information,clinical characteristics,and imaging data of all cases were collected.All patients underwent submaximal balloon dilation and small-diameter stent implantation.Preoperative comorbidities or risk factors included hypertension 23 cases(76.7%),diabetes 10 cases(33.3%),hyperglycemia 14 cases(46.7%),moking 13 cases(43.3%).Left main trunk disease 6 cases(20.0%),three-vessels disease 24 cases(80.0%),mitral regurgitation 1 case(3.3%),stable angina 25 cases(83.3%),myocardial infarction 8 cases(26.7%),cerebral infarction 24 cases(80.0%)and transient ischemia attack(TIA)6 cases(20.0%)caused by ipsilateral carotid artery stenosis.The median National Institutes of Health Stroke Scale(NIHSS)score was 2(0-3),and the median modified Rankin Scale(mRS)score was 1(0-1)before the operation.The mean interval between carotid artery intervention and CABG was(23.4±8.2)days.Results 29 cases(96.7%,29/30)underwent CAS-CABG operation successfully.In one case of carotid artery extreme tortuosity,the emboli protective device could not place the distal carotid artery.In the operative procedure,27 cases(90.0%,27/30)underwent with 3mm diameter balloon,only 3 cases(10.0%)with 3 mm balloon after pre-dilatation with 2 mm diameter balloon because of severely high-grade stenosis(99%).25 cases(83.3%)with 7mm diameter stents and 5 cases(16.7%)with 6 mm diameter stents,including 22 cases(73.3%)with a closed-cell stent and 8 cases(26.7%)with an open-cell stent.In the perioperative period,the heart rate of two patients was lower than 50 BPM during operation and ret

关 键 词：颈动脉狭窄 支架置入术 冠状动脉旁路移植术 安全性 

分 类 号：R651.1[医药卫生—外科学]