颈动脉重度狭窄合并冠状动脉多支病变分期治疗后院内并发症分析  

Analysis of in-hospital complications after staging treatment of severe carotid artery stenosis with multi-branch coronary artery disease

作　　者：范承哲[1] 张楠[1] 梁林[2] 许保磊[3] Fan Chengzhe;Zhang Nan;Liang Lin;Xu Baolei(Department of Neurointervention,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,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安贞医院微创心脏外科中心,100029 [3]首都医科大学宣武医院国家老年疾病临床医学研究中心

出　　处：《中国脑血管病杂志》2022年第3期167-174,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：北京市自然科学基金资助项目(7202059)。

摘　　要：目的研究颈动脉重度狭窄合并冠状动脉多支病变分期手术后院内并发症发生情况。方法回顾性连续纳入2006年4月至2020年12月首都医科大学附属北京安贞医院颈动脉重度狭窄联合冠状动脉多支病变且二者均完成手术治疗的患者,颈动脉重度狭窄均采用颈动脉支架置入术(CAS),冠状动脉多支病变均采用非体外循环下冠状动脉旁路移植术(CABG),先行CAS,术后6个月内完成非体外循环CABG。观察CAS及CABG术后院内并发症(短暂性脑缺血发作、卒中、心肌梗死)及死亡的发生情况。结果共纳入患者30例,其中男27例,女3例;年龄54~76岁,平均(64±5)岁。CAS及非体外循环CABG院内并发症发生率为23.3%(7/30例),其中CAS院内并发症发生率为13.3%(4/30例;短暂性脑缺血发作3例,脑梗死1例),非体外循环CABG院内并发症发生率为10.0%(3/30例;腔隙性脑梗死1例,脑梗死2例)。术后所有患者未发生心肌梗死及死亡。结论颈动脉重度狭窄联合冠状动脉多支病变分期CAS+CABG治疗具有较好的安全性,但需要在相关科室配套完善的医院内实施较为合适。Objective To investigate the in-hospital complications after staging treatment of severe carotid artery stenosis complicated with multi-branch coronary artery disease.Methods From April 2006 to December 2020,patients with severe carotid artery stenosis combined with multi-branch coronary artery disease were retrospectively enrolled in Beijing Anzhen Hospital,Capital Medical University.All patients underwent carotid artery stenting(CAS)for carotid artery stenosis and off-pump coronary artery bypass grafting(CABG)for multi-branch coronary artery disease.CAS was performed first,and CABG was completed within 6 months after CAS.The incidence of in-hospital complications(transient ischemic attack,stroke,myocardial infarction)and death after CAS and CABG was observed.Results A total of 30 cases were included in this study,including 27 males and 3 females.The age ranged from 54 to 76 years,with an average of(64±5)years.The incidence of complications in CAS and off-pump CABG was 23.3%(7/30 cases),among which the incidence of complications in CAS and off-pump CABG was 13.3%(4/30 cases,3 cases of transient ischemic attack,1 case of cerebral infarction)and 10.0%(3/30 cases,lacunar cerebral infarction in 1 case and cerebral infarction in 2 cases,respectively).No myocardial infarction or death occurred during perioperative period.Conclusion The staging treatment of CAS+CABG for severe carotid artery stenosis combined with multi-branch coronary artery disease has acceptable safety,but it should be carried out in hospitals with sound related departments.

关 键 词：颈动脉狭窄 颈动脉支架术 冠心病 冠状动脉旁路移植术 

分 类 号：R541.4[医药卫生—心血管疾病] R543.4[医药卫生—内科学]