介入再通术治疗不同程度同侧慢性颈动脉闭塞的临床疗效及对预后的影响分析  

Clinical efficacy and prognosis of interventional recanalization in the treatment of ipsilateral chronic carotid occlusion

作　　者：王利宇 郑立宏[1] 陈爱国[1] 刘震 WANG Li-yu;ZHENG Li-hong;CHEN Ai-guo(Department of Neurointerventional,Neurological Disorders Center,Beijing Shunyi Hospital,Beijing 101300,China)

机构地区：[1]北京市顺义区医院神经疾病中心神经介入科,北京101300

出　　处：《临床和实验医学杂志》2023年第10期1057-1061,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市重点医学专科课题辅助项目(编号:Wsjzkyfzzx-z-03)。

摘　　要：目的探讨介入再通术治疗不同程度同侧慢性颈动脉闭塞临床疗效及对预后的影响。方法回顾性分析2019年1月至2021年1月在北京市顺义区医院接受血管再通治疗的慢性颈动脉闭塞32例患者的临床资料。依据Hasan分型,将同侧慢性颈动脉闭塞患者分为A型、B型、C型和D型,采用单纯血管内介入术和复合手术进行治疗。观察不同分型和不同手术方式同侧慢性颈动脉闭塞患者再通介入治疗的介入再通成功率、30 d围手术期并发症的发生率和3个月随访通畅率;对比治疗前和治疗后7 d蒙特利尔量表评估认知功能改善情况和3个月Rankin量表评估神经改善情况。结果32例患者中,按照Hasan分型,A型11例,B型9例,C型8例,D型4例。4种类型患者的年龄、性别构成比比较,差异均无统计学意义(P>0.05),而4种类型患者的高血压病史、糖尿病史、冠心病史、长期吸烟史、长期饮酒史、夹层、大动脉粥样硬化性以及慢性颈动脉闭塞表现比较,差异均有统计学意义(P<0.05)。A型介入再通成功率明显高于B型、C型和D型,差异均有统计学意义(P<0.05),A型、B型、C型围手术期并发症的发生率和随访通畅率比较,差异均无统计学意义(P>0.05)。治疗后,D型的mRS评分显著高于A型、B型、C型,蒙特利尔评分明显低于A型、B型、C型,差异均有统计学意义(P<0.05);A型、B型、C型治疗后mRS评分明显低于治疗前,差异均有统计学意义(P<0.05);A型、B型、C型治疗后蒙特利尔评分均显著高于治疗前,差异均有统计学意义(P<0.05),D型治疗前后mRS和蒙特利尔评分比较,差异均无统计学意义(P>0.05)。结论介入再通术治疗同侧慢性颈动脉闭塞介入再通成功率和随访再通率随闭塞程度的加重而降低,围手术期并发症的发生率随闭塞程度的加重而增高,术后神经功能和认知功能改善的改善随闭塞程度的加重而变差。采用单纯血管内介入术介入治疗慢Objective To explore the clinical efficacy of interventional recanalization in the treatment of ipsilateral chronic carotid artery occlusion and its impact on prognosis.Methods Clinical data of 32 patients with chronic carotid artery occlusion who received vascular recanalization in the Beijing Shunyi Hospital from January 2019 to January 2021 were analyzed retrospectively.According to Hasan classification,patients with ipsilateral chronic carotid artery occlusion were divided into type A,B,C and D,and treated with simple intravascular intervention and combined surgery.The success rate of interventional recanalization,the incidence of 30 day perioperative complications and the patency rate of 3-month follow-up were observed.Results Among the 32 patients,according to Hasan classification,there were 11 cases of type A,9 cases of type B,8 cases of type C,and 4 cases of type D.There was no statistically significant difference in age and sex among the four tapes of patients(P>0.05),but there were statistically significant differences in hypertension history,diabetes history,coronary heart disease history,long-term smoking history,long-term drinking history,dissection,major atherosclerosis and chronic carotid artery occlusion among the four tapes of patients(P<0.05).The success rate of type A intervention recanalization was significantly higher than that of type B,C,and D,the difference was statistically significant(P<0.05),and there was no statistically significant difference in the incidence of perioperative complications and follow-up patency rates among type A,B,and C(P>0.05).After treatment,the mRS score of type D was significantly higher than that of type A,B,and C,while the Montreal score was significantly lower than that of type A,B,and C,the differences were statistically significant(P<0.05).The mRS scores of type A,type B,and type C after treatment were significantly lower than those before treatment,the differences were statistically significant(P<0.05);the Montreal scores of type A,B,and C after treatment w

关 键 词：同侧慢性颈动脉闭塞 介入再通 血管内治疗 临床疗效 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]