颈动脉内膜切除术与颈动脉支架置入术对颈动脉狭窄治疗效果的单中心临床研究  

A single-center clinical study of carotid endarterectomy and carotid artery stenting in the treatment of carotid artery stenosis

作　　者：武倡臣 穆德勇 刘昱甫 吴小钢 彭岗 王凡 WU Changchen;MU Deyong;LIU Yufu;WU Xiaogang;PENG Gang;WANG Fan(Department of Neurosurgery,Affiliated Baiyun Hospital of Guizhou Medical University,Guiyang 550014,China;Department of Neurosurgery,Affiliated Hospital of Guizhou Medical University,Guiyang 550001,China)

机构地区：[1]贵州医科大学附属白云医院神经外科,贵州贵阳550014 [2]贵州医科大学附属医院神经外科,贵州贵阳550001

出　　处：《空军军医大学学报》2025年第2期198-204,共7页Journal of Air Force Medical University

基　　金：中国脑卒中高危人群干预适宜技术研究及推广项目(GN2018R005)。

摘　　要：目的对比分析颈动脉内膜切除术(CEA)和颈动脉支架置入术(CAS)在颈动脉狭窄治疗中的安全性和有效性,探讨两种手术方式在临床疗效方面的差异。方法前瞻性分析2018年9月至2021年9月接受CEA或CAS治疗的161例颈动脉狭窄患者的临床资料。结果术后随访1年后,两组患者在术后6个月及1年随访复查B超,斑块检出率及再狭窄率CEA组明显低于CAS组(P<0.01);CEA组术后美国国立卫生研究院卒中量表(NIHSS)评分及简易智能精神状态检查量表(MMSE)评分改善情况比CAS组好(P<0.01),术前存在轻微梗死灶者,CEA在术后对改良Rankin评分量表(mRS)评分改善情况比CAS好(P<0.01),差异具有统计学意义。结论CEA组患者术后6个月及术后1年随访复查B超的斑块检出率明显低于CAS组,且CEA组患者再狭窄率较CAS组更低;两组治疗后均能改善患者神经功能状态及认知功能,CEA组患者术后NIHSS评分及MMSE评分改善程度更好,对于术前存在梗死灶者,CEA对mRS评分改善更明显。Objective To compare and analyze the safety and effectiveness of carotid endarterectomy(CEA) and carotid artery stenting(CAS) in the treatment of carotid artery stenosis,and explore the differences in clinical efficacy between the two surgical methods.Methods A prospective analysis was conducted on the clinical data of 161 patients with carotid artery stenosis who received CEA or CAS treatment from September 2018 to September 2021.Results After 1 year of follow-up,both groups of patients underwent B-ultrasound at 6 months and 1 year of follow-up.The plaque detection rate and restenosis rate in CEA group were significantly lower than those in CAS group(P<0.01).The improvement of postoperative National Institutes of Health Stroke Scale(NIHSS) and Mini-Mental State Examination(MMSE) in CEA group was better than that in CAS group(P<0.01).For patients with mild infarction before surgery,the improvement of modified Rankin Scale(mRS) in CEA group was better than that in CAS group(P<0.01),and the difference was statistically significant.Conclusion The plaque detection rate of B-ultrasound follow-up at 6 months and 1 year after surgery in CEA group is significantly lower than that in CAS group,and the restenosis rate in CEA group is lower than that in CAS group.After treatment,both groups are able to improve the neurological and cognitive function of patients.The CEA group shows better improvement in postoperative NIHSS and MMSE.For patients with preoperative infarction,CEA shows more significant improvement in mRS.

关 键 词：颈动脉狭窄 颈动脉内膜切除术 颈动脉支架置入术 脑卒中 

分 类 号：R651.1[医药卫生—外科学]