颈动脉硬化狭窄腔内治疗中钙化病变的处理与临床结局  

Clinical outcomes of severe calcified lesions after carotid artery stenting

作　　者：唐骁 唐涵斐 符伟国 岳嘉宁 史振宇 司逸 李炜淼 林长泼 郭宝磊 郭大乔 Tang Xiao;Tang Hanfei;Fu Weiguo;Yue Jianing;Shi Zhenyu;Si Yi;Li Weimiao;Lin Changpo;Guo Baolei;Guo Daqiao(Department of Vascular Surgery,Zhongshan Hospital,Fudan University,National Clinical Research Center for Interventional Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院血管外科,复旦大学血管外科研究所,国家放射与治疗临床医学研究中心,上海200032

出　　处：《中华普通外科杂志》2022年第3期175-179,共5页Chinese Journal of General Surgery

基　　金：国家自然科学基金(81970408,82100516);上海市青年科技英才扬帆计划(20YF1406700);上海市科学技术委员会医学引导类科技支撑项目(19411966900)。

摘　　要：目的评价脑保护下颈动脉支架成形术(carotid artery stenting,CAS)治疗颈动脉非环状重度钙化狭窄的安全性及有效性。方法回顾性分析2018年1月至2020年12月在本中心接受CAS手术治疗的颈动脉狭窄患者中非环状重度钙化病变患者的临床及随访资料,评估技术成功率、围手术期并发症发生率,随访支架内再狭窄/闭塞发生率。结果CAS手术治疗非环状重度钙化(钙化弧度>270°)病变226例次,技术成功率为90.26%。围手术期无死亡或心肌梗死等严重并发症发生,2例患者于球囊后扩时出现手术侧脑卒中,围手术期心动过缓/低血压发生率为25.34%。患者术后中位随访时间17.3个月,随访结果显示轻中度再狭窄(<70%)的发生率为16.59%,重度再狭窄或闭塞(>70%)的发生率为3.22%。结论对于非环状重度钙化且合并颈动脉内膜切除术高危因素的患者,通过采取积极的预扩策略和严格的支架选择及植入标准,CAS手术仍具有良好的疗效,围手术期死亡、心肌梗死或缺血性脑卒中的发生率较低,近中期支架通畅率满意。Objective To evaluate the safety and efficacy of carotid artery stenting(CAS)in the treatment of non-circumferential severe calcification using the distal embolic protection device.Methods Clinical data of patients with severe calcification lesions in cervical carotid artery treated by CAS from Jan 2018 to Dec 2020 at our center was analyzed retrospectively.Results 226 consecutively admitted patients of cervical carotid artery stenosis and non-circumferential severe calcification(CR>270°)underwent CAS using the distal embolic protection device.The technical success rate was 90.26%.No death or myocardial infarction occurred during the perioperative period.Two patients had ipsilateral hemiparesis ischemic stroke during post-dilatation.The incidence of perioperative bradycardia/hypotension was 25.34%.Patients were followed up for 6-36 months,with median follow-up period of 17.3 months.The incidence of mild or moderate in-stent restenosis(<70%)was 16.59%,and the incidence of severe in-stent restenosis or occlusion(>70%)was 3.22%.Conclusions For carotid artery stenosis with non-circumferential severe calcification in high risk for CEA patients,carotid artery stenting is safe and effective with the aggressive pre-dilation strategies,strict stent selections and implantation standards.The incidence of perioperative death,myocardial infarction or ipsilateral hemiparesis ischemic stroke was low.The patency rate of the carotid stent in the calcification lesion is satisfactory during the mid-term follow-up.

关 键 词：颈动脉狭窄 支架 钙化 缺血性脑卒中 支架内再狭窄 

分 类 号：R651.1[医药卫生—外科学]