颈动脉支架置入常规后扩张与否的对比性研究  

Outcomes and complications of conventional post-dilatation versus selective post-dilatation during carotid artery stenting

作　　者：王清媛 陈忠[1] 寇镭[1] 周游 WANG Qingyuan;CHEN Zhong;KOU Lei;ZHOU You(Department of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所血管外科,100029

出　　处：《心肺血管病杂志》2022年第2期168-172,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:比较在颈动脉支架置入术(CAS)中常规后扩张与选择性后扩张的疗效和并发症发生率。方法:本研究回顾性收集北京安贞医院血管外科2016年1月至2019年12月,收治行CAS治疗并随访满1年的患者临床资料,基于术中接受常规后扩张和选择性后扩张进行分组,近远期通畅率及并发症发生率。结果:本研究共纳入314例患者,其中常规后扩张组150例,选择性后扩张组164例(选择性扩张61例,选择性未扩张103例)。两组患者临床基线资料方面差异无统计学意义。术后均无手术相关死亡发生。常规后扩张组与选择性后扩张组术后以下并发症(缺血性卒中、急性心肌梗死、高灌注综合征)发生率,差异均无统计学意义;常规后扩张组持续低血压发生率显著高于选择性后扩张组(46%vs. 28%, P=0.001)。1年随访结果表明,常规后扩张组治疗侧颈动脉再狭窄(> 50%)发生率显著低于选择性后扩张组(8%vs. 17.1%, P=0.016);选择性扩张治疗侧颈动脉再狭窄50%~70%发生率显著低于选择性未扩张(6.6%vs.17.5%, P=0.047);而两组治疗侧术后1年卒中发生率,差异均无统计学意义。结论:在颈动脉支架置入术中,常规后扩张较选择性后扩张可能会降低术后再狭窄的发生率。虽然血流动力学改变(持续性低血压)是CAS围手术期最常见的并发症,但经药物治疗使血压恢复后,症状可明显缓解,并避免发生永久性神经功能损伤。Objective: To compare conventional post-dilatation and selective post-dilatation during carotid artery stenting(CAS) in regard to their outcomes and complications in treating carotid artery stenosis.Methods: This study retrospectively collected the clinical data of patients who were treated with CAS from January 2016 to December 2019 in the Department of Vascular Surgery, Beijing Anzhen Hospital, and were followed up for 1 year. They were divided into conventional post-dilatation group and selective postdilatation group. The clinical outcomes and complications of conventional post-dilatation and selective postdilatation were compared. Results: 314 patients were enrolled in the study, among which 150 were included in conventional post-dilatation group and 164 included in selective post-dilatation group. There was no significant difference in clinical baseline data between the two groups. No operation-related death and extracranial nerve injury occurred in both groups. There was no significant difference in the incidence of the following complications(ischemic stroke, acute myocardial infarction, and hyper perfusion syndrome) between the conventional postdilatation group and the selective post-dilatation group. The incidence of persistent hypertension in the conventional post-dilatation group was significantly higher than that in the selective post-dilatation group(46.0% vs. 28%,P = 0.001). The 1-year follow-up results showed that the incidence of carotid artery restenosis(> 50%) in the conventional post-dilatation group was significantly lower than that in the selective post-dilatation group(8%vs. 17.1%, P = 0.016);The incidence of arterial restenosis(50%~70%) was significantly lower than that of selective undilated(6.6% vs. 17.5%, P = 0.047);however, there was no statistically significant difference in the incidence of stroke in each group after 1 year.Conclusions: Routine post-dilation during carotid stent implantation may reduce the incidence of restenosis after surgery. Although hemodynamic changes(persistent

关 键 词：颈动脉狭窄 颈动脉支架 常规性后扩张 选择性后扩张 持续性低血压 

分 类 号：R54[医药卫生—心血管疾病]