颈动脉内膜剥脱术与颈动脉支架置入术治疗颈动脉狭窄的短期疗效与安全性对比  

Comparison of short-term efficacy and safety of carotid endarterectomy and carotid artery stenting in the treatment of carotid artery stenosis

作　　者：杨馥锟 钱陈泽越 陈兆雷 邱信杰 朱健 Yang Fukun;Qian Chenzeyue;Chen Zhaolei;Qiu Xinjie;Zhu Jian(School of Medicine,Jiangsu University,Zhenjiang 212013,Jiangsu,China;Department of Vascular Surgery,Subei People's Hospital of Jiangsu Province,Yangzhou 225001,Jiangsu,China;Department of Vascular Surgery,the First People's Hospital of Kunshan,Suzhou 215300,Jiangsu,China)

机构地区：[1]江苏大学医学院,江苏镇江212013 [2]苏北人民医院血管外科,江苏扬州225001 [3]昆山市第一人民医院血管外科,江苏苏州215300

出　　处：《血管与腔内血管外科杂志》2022年第10期1156-1160,1164,共6页Journal of Vascular and Endovascular Surgery

基　　金：苏州市科技计划项目(SYSD2018021)。

摘　　要：目的探讨颈动脉内膜剥脱术(CEA)与颈动脉支架置入术(CAS)治疗颈动脉狭窄的短期疗效及安全性。方法收集2019年1月至2021年1月苏北人民医院、昆山市第一人民医院收治的72例颈动脉狭窄患者的临床资料,根据手术治疗方式的不同将患者分为CEA组(n=32)和CAS组(n=40)。观察两组患者的手术情况及术后临床症状缓解情况、不良事件发生情况。观察术后1年内所有患者的支架内再狭窄、缺血性脑卒中、心肌梗死、死亡等情况。结果两组患者均顺利完成手术。两组的临床症状缓解情况比较,差异无统计学意义(P>0.05)。术后7 d,两组均无患者出现心肌梗死及手术相关死亡;两组患者缺血性脑卒中,切口或穿刺点血肿、感染,颅神经损伤(CNI),脑过度灌注综合征(CHS),颈动脉窦反应(CSR),股动脉假性动脉瘤的发生率比较,差异均无统计学意义(P>0.05)。CAS组术后8个月出现1例中度支架内再狭窄,术后10个月出现1例缺血性脑卒中,术后11个月出现1例重度支架内再狭窄。术后1年内,CEA组未出现上述不良事件。两组患者的术后1年随访情况比较,差异无统计学意义(P>0.05)。结论在颈动脉狭窄的治疗中,CEA和CAS两种术式均安全有效,各具优势,特点突出,临床实践中应充分评估患者的病情特点,在此基础上确定最佳治疗方案,满足个体化要求。Objective To investigate the short-term efficacy and safety of carotid endarterectomy(CEA)and carotid artery stenting(CAS)in the treatment of carotid artery stenosis.Method The clinical data of 72 patients with carotid artery stenosis admitted to Subei People's Hospital of Jiangsu Province and the First People's Hospital of Kunshan from January 2019 to January 2021 were collected,the patients were divided into CEA group(n=32)and CAS group(n=40)according to different surgical treatment methods.The surgical conditions,postoperative clinical symptom relief,and adverse events were observed in the two groups of patients.The surgical site,ischemic stroke,myocardial infarction,death and so on were observed in all patients at 1 year after the surgery.Result There was no significant difference in the remission of clinical symptoms between the two groups(P>0.05).At 7 days after surgery,there was no myocardial infarction or surgery-related death in either group.There were no significant differences in the incidence of ischemic stroke,incision or puncture point hematoma,infection,cranial nerve injury(CNI),cerebral hyperperfusion syndrome(CHS),carotid sinus reaction(CSR),and femoral artery pseudoaneurysm between the two groups(P>0.05).At 8 months after surgery,1 case patient of moderate stent restenosis occurred in CAS group;1 case patient of ischemic stroke occurred 10 months after surgery;at 11 months after surgery,1 case patient had severe in stent restenosis.Within 1 year after surgery,there was no above related adverse event in CEA group.There was no significant difference in the 1-year follow-up between the two groups(P>0.05).Conclusion When it comes to treating carotid artery stenosis,both CEA and CAS are safe and effective.The two methods have their advantages and features.The characteristics of the patient's condition should be fully evaluated in clinical practice,and the optimal treatment plan should be determined on this basis to meet individualized requirements.

关 键 词：颈动脉内膜剥脱术 颈动脉支架置入术 颈动脉狭窄 缺血性脑卒中 短期疗效 

分 类 号：R543.4[医药卫生—心血管疾病]