单中心颈动脉内膜切除术和颈动脉支架置入术治疗颈动脉狭窄的临床结局及认知功能分析  

Clinical and cognitive outcomes of CEA versus CAS in treatment of stenoses of muscular artery:A single center study

作　　者：杨晨轩 薛哲[1] 武琛[1] 于博文 许百男[1] YANG Chenxuan;XUE Zhe;WU Chen;YU Bowen;XU Bainan(Department of Neurosurgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心神经外科,北京100853

出　　处：《解放军医学院学报》2021年第5期509-512,559,共5页Academic Journal of Chinese PLA Medical School

摘　　要：背景近年来关于颈动脉内膜切除术(carotid endarterectomy,CEA)和颈动脉支架置入术(carotid artery stenting,CAS)治疗颈动脉狭窄后认知功能改变的研究,可能为颈动脉狭窄治疗方式的选择提供新的思路。目的探讨CEA、CAS治疗颈动脉狭窄的有效性和对认知功能产生的影响。方法回顾性分析2018年9月-2020年9月于解放军总医院第一医学中心治疗的颈动脉狭窄患者病例,比较CEA组与CAS组相关疗效指标(总有效率及脑缺血、脑梗死、再狭窄发生率)和蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)得分。结果共计103例患者纳入分析,其中CEA组54例、CAS组49例,两组基线资料差异无统计学意义。CEA组、CAS组不良事件(脑缺血、脑梗死、再狭窄)发生总例数分别为8例(14.81%)和5例(10.20%),差异无统计学意义(P=0.458)。CAS组总有效率83.67%(41/49),高于CEA组的66.67%(36/54)(P=0.047)。两组术前MoCA评分差异无统计学意义,术后3个月CAS组MoCA评分(23.26±2.55)高于CEA组(18.48±2.41),差异有统计学意义(P<0.001)。结论 CEA和CAS均能改善颈动脉狭窄,不良事件少、安全性高;但接受CAS治疗的患者认知功能得分和总有效率更高。Background In recent years,attention has been paid to the relationship between effect of carotid endarterectomy(CEA)or carotid artery stenting(CAS)in the treatment of carotid artery stenosis and cognitive function,which may provide new ideas for treatment of carotid stenosis.Objective To compare the clinical and cognitive outcomes of CEA versus CAS in the treatment of carotid artery stenosis.Methods Patients with carotid artery stenosis undergoing CEA or CAS in the First Medical Center of Chinese PLA General Hospital from September 2018 to September 2020 were enrolled.Clinical indexes(total effective rate,adverse events incidence cerebral ischemia,cerebral infarction and restenosis)and Montreal Cognitive Assessment Scale(MoCA)scores were recorded and compared between the two groups.Results Finally 103 cases were included in the analysis,54 cases in the CEA group and 49 cases in the CAS group.The adverse events(including cerebral ischemia,cerebral infarction and restenosis)occurred in 8 cases(14.81%)in the CEA group and 5 cases(10.20%)in the CAS group,but the difference was not statistically significant(P=0.458).The total effective rate of the CAS group was significantly higher than that of the CEA group(83.67%[41/49]vs 66.67%[36/54],P=0.047).The MOCA score at baseline were similar between the two groups;at 3 months after operation,it was higher in CAS group(23.26±2.55)compared to the CEA group(18.48±2.41)(P<0.001).Conclusion CEA and CAS are effective in the treatment to carotid artery stenosis,with few adverse events and high safety,while CAS group have better cognitive function and higher total effective rate.

关 键 词：颈动脉内膜切除术 颈动脉支架置入术 颈动脉狭窄 疗效 认知功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]