颈动脉支架植入术治疗症状性颈动脉狭窄23例疗效观察及影响因素分析

目的:探讨颈动脉支架植入术治疗症状性颈动脉狭窄患者的临床疗效及相关影响因素。方法:将46例症状性颈动脉狭窄行颈动脉支架植入术患者随机分为对照组和观察组各23例,对照组采用传统药物保守治疗,观察组给予颈动脉支架植入术治疗,比较两组终末事件发生率,分析观察组终末事件的影响因素。结果:观察组终末事件发生率低于对照组(P0.05);观察组终末事件影响因素包括年龄、危险因素、高血压、规范抗血小板治疗(P0.05)。结论:颈动脉支架植入术治疗症状性颈动脉狭窄患者效果较好,应重视其影响因素并积极干预。     

颈动脉内支架成形术在缺血性脑卒中患者二级预防中的效果观察

72例缺血性脑卒中患者入院后行常规检查及基础降糖降脂降压治疗。研究组行颈动脉内支架成形术,术后应用肝素抗凝和阿司匹林口服100mg/次/d,3d后仅服用阿司匹林。对照组患者仅采用阿司匹林预防治疗,剂量同研究组。所有患者行颈动脉彩超及脑血管造影检查。比较患者治疗前、治疗3个月、6个月、12个月的神经功能缺损评分(NIHSS)、日常生活能力评分(ADL)、颈动脉直径、颈动脉直径狭窄率。结果经治疗,两组患者NIHSS、ADL评分、颈动脉直径、颈动脉直径狭窄率均有一定改善,同期组间比较,研究组均显著高于对照组(P0.05)。两组不良反应发生率分别为14.3%、11.8%,无统计学差异。颈动脉内支架成形术可有效改善患者颈动脉狭窄,扩大管腔,复发率低,预防缺血性脑卒中效果良好。     

精准血压管理对颈动脉狭窄行颈动脉支架植入术患者的影响

目的:探讨精准血压管理对颈动脉狭窄行颈动脉支架植入术患者的影响。方法:将80例颈动脉狭窄行颈动脉支架植入术患者根据入院顺序分为对照组和观察组各40例,对照组实施常规护理,观察组在对照组基础上实施精准血压管理,比较两组干预效果。结果:观察组高血压行为依从性优于对照组(P0.05),术后并发症发生率低于对照组(P0.05)。两组干预后血压优于干预前(P0.05),观察组干预后血压优于对照组(P0.05)。结论:精准血压管理可提高颈动脉狭窄行颈动脉支架植入术患者的血压行为依从性,减少并发症,维持血压稳定。     

分期介入治疗颈动脉狭窄合并冠心病的临床疗效及随访效果观察

目的探讨分期介入治疗颈动脉狭窄合并冠心病的临床疗效及随访效果。方法选取2008年10月至2012年10月期间收治的78例颈动脉狭窄合并冠心病患者,随机分为观察组和对照组,每组39例,两组患者均行经皮冠状动脉介入(PCI)治疗和颈动脉支架术(CAS),观察组患者行分期介入治疗,对照组患者行同期介入治疗。对比观察两组患者的治疗效果、并发症以及随访效果。结果观察组的临床治疗总有效率(97.4%)明显高于对照组(79.5%),差异有统计学意义(P0.05);观察组治疗过程中的总并发症发生率(10.3%)明显低于对照组(38.5%),差异有统计学意义(P0.05)。手术后进行长期随访发现,观察组患者支架内狭窄、血管闭塞、心肌梗死以及脑梗死的发生率(0,0,2.6%,5.1%)明显低于对照组(7.7%,10.3%,12.8%,17.9%),差异均有显著性(P0.05)。两组患者的肾功能术前术后比较差异均无统计学意义(P0.05),且组间比较术前术后差异也无统计学意义(P0.05)。结论对于颈动脉狭窄合并冠心病患者,分期先行PCI术后再行CAS术治疗,不仅疗效显著,合并症发生率低,且同时长期随访效果好,安全可靠,是临床上一种安全有效的治疗方式。     

分期介入治疗颈动脉狭窄合并冠心病患者的疗效及随访效果观察

目的探讨分期介入治疗颈动脉狭窄合并冠心病患者的及随访效果。方法选取2008年10月至2012年10月期间在该院就诊的78例颈动脉狭窄合并冠心病患者,随机分为观察组和对照组,每组39例,两组患者均行经皮冠状动脉介入治疗(PCI)和颈动脉支架术(CAS),观察组患者行分期介入治疗,对照组患者行同期介入治疗。对比观察两组患者的治疗效果、并发症以及随访效果。结果观察组患者的临床治疗总有效率为97.4%,对照组患者的临床总有效率为79.5%,两组间差异有统计学意义(P0.05);观察组患者在治疗过程中的并发症发生率10.3%,对照组患者的并发症发生率为38.5%,差异有统计学意义(P0.05);手术后进行长期随访发现,观察组患者支架内狭窄、血管闭塞、心肌梗死以及脑梗死的发生率情况均显著低于对照组,差异有统计学意义(P0.05)。两组患者的肾功能术前术后比较差异均无统计学意义(P0.05),且组间比较术前术后差异也无统计学意义(P0.05)。结论对于颈动脉狭窄合并冠心病患者,分期先行PCI术后再行CAS术治疗不仅疗效显著,并发症发生率低,且同时长期随访效果好,安全可靠,是临床上一种安全有效的治疗方式。     

无症状颈动脉狭窄患者的认知状况研究

目的探讨无症状颈动脉狭窄与认知功能障碍的关系。方法选取2013年1月至2014年1月收治的100例无症状颈动脉狭窄患者为观察组,另选择同期门诊体检正常者100例为对照组。采用简易智能状态检查量表对两组进行认知功能评分,比较两组的临床资料,分析无症状颈动脉狭窄和认知功能障碍的关系。对比观察组颈动脉支架植入术后1周、1个月、3个月、6个月智能状态检查量表得分。结果观察组认知功能评分明显低于对照组,差异有统计学意义(P0.05)。观察组患者进行颈动脉支架植入术治疗后1个月、3个月、6个月智能状态检查量表评分分别为:27.3±1.2分,28.5±1.0分,28.9±0.9分,与治疗前比较差异有统计学意义(P0.05)。无症状颈动脉狭窄治疗后1个月时,患者的认知功能开始改善,治疗后1个月到3个月随着时间的延长认知功能改善越来越明显,而在治疗后3个月到6个月认知功能无明显改善。患者的连线测试、顺背测试评分、词汇测试得分降低(P0.05)。结论无症状颈动脉狭窄引发患者认知障碍,主要损害患者的认知转换、执行功能和注意功能。     

循证护理在减少颈动脉支架置入术后并发症中的应用

目的:运用循证护理的方法针对颈动脉支架置入术后患者采取预防措施。方法:选择114例住院治疗的颈动脉支架置入患者,将其随机分为对照组56例和观察组58例。对照组采用支架置入术后常规护理,观察组应用循证护理方法指导颈动脉支架置入术后护理。两组患者均行全脑血管造影检查,提示为颈动脉狭窄程度70%～95%。比较两组术后并发症的发生情况。结果:观察组患者颈动脉支架置入术后并发症的发生情况低于对照组(P0.05)。结论:循征护理在减少颈动脉支架置入术后并发症中发挥着积极的作用。     

脑保护装置下的颈动脉狭窄支架成形术:28例短期随访脑缺血事件再发生率

目的:观察脑保护装置下颈动脉狭窄支架成形术对脑缺血事件发生的二级康复干预作用。方法:解放军第三军医大学第一附属医院神经内科2003-01/2004-06收治28例症状性颈动脉狭窄患者,在进行颈动脉狭窄支架成形术中采用过滤伞装置,将脑保护装置(保护伞)小心通过狭窄部位放置于颈动脉狭窄的远端并释放,然后进行狭窄的血管内支架成形术,观察手术期脑栓塞发生的情况及其他并发症。结果:28例保护伞放置及支架成形术均成功实施。支架释放前颈动脉的平均直径狭窄率为(87.6±6.8)%,支架释放后颈动脉的平均直径狭窄率为(18.9±10.8)%。释放后颈动脉的平均直径狭窄率明显的降低(P<0.01)。操作过程中未发生栓塞等并发症。结论:脑保护装置能提高颈动脉狭窄支架成形术的安全性,同时,临床短期随访无脑缺血事件发生。     

颈动脉支架成形术对颈动脉狭窄患者认知功能的影响

目的:探讨颈动脉支架成形术(CAS)对颈动脉狭窄患者认知功能的影响。方法:216例颈动脉狭窄患者行CAS,在治疗前及治疗后1、3、6、12月应用简易精神状态检查量表(MMSE)、物体记忆测验(FOM)及语言流畅性测验(RVR)观察认知功能的变化。结果:CAS手术成功率100%。治疗后1、3、6、12月患者的MMSE、FOM、RVR评分与治疗前比较,明显改善(P<0.01),且随随访时间延长变化越明显。狭窄程度越高的患者术后认知改善越明显,认知改善程度无症状患者>TIA患者>脑梗死患者。结论:随访期间,CAS可以改善颈动脉狭窄患者的认知功能。     

经颅多普勒超声屏气试验评价重度颈动脉狭窄脑血管储备功能

目的:应用经颅多普勒超声(TCD)屏气试验评价重度颈动脉狭窄患者脑血管储备(CVR)功能。方法:选取30例健康对照者(正常对照组)、26例单侧重度颈动脉狭窄患者(颈动脉狭窄组),其中无症状性颈动脉狭窄14例(无症状亚组)、症状性颈动脉狭窄12例(症状亚组)。症状亚组中9例行颈动脉支架置入(CAS)术。比较各组患者的屏气指数(BHI),评估CVR功能。结果:与正常对照组比较,颈动脉狭窄组狭窄侧的BHI明显降低(P=0.000);与无症状亚组狭窄侧相比,症状亚组狭窄侧BHI明显降低(P=0.000);颈动脉狭窄组症状亚组患者CAS术后狭窄侧BHI与术前比较升高(P=0.021),术后狭窄侧的BHI低于健侧(P=0.019)。结论:重度颈动脉狭窄患者狭窄侧CVR功能降低,症状性颈动脉狭窄患者较无症状性颈动脉狭窄患者降低更明显,CAS可以改善症状性颈动脉狭窄患者CVR功能。     

颈动脉内膜剥脱术治疗症状性颈动脉狭窄围术期护理

目的：探讨颈动脉内膜剥脱术治疗症状性颈动脉狭窄围术期的护理效果。方法选取2014年1月至2015年1月在本院接受治疗的症状性颈动脉狭窄患者108例为研究对象,随机分为观察组( n=54)和对照组(n=54),两组均行颈动脉内膜剥脱术。两组患者在围术期均实施护理干预,给予对照组围手术期常规的护理干预措施,给予观察组围手术期整体护理干预措施。对两组患者的焦虑自评量表( SAS)评分和抑郁自评量表( SDS)评分、并发症发生情况、护理工作满意度进行评估和比较。结果两组患者在干预前,其SAS评分以及SDS评分差异不具有统计学意义( P>0.05),而观察组在经整体护理干预之后,其SAS评分以及SDS评分显著优于常规护理干预的对照组( P<0.05);对照组的并发症发生率为18.52%,明显高于观察组( P<0.05);与对照组相比,观察组的护理质量满意度更为显著,明显高于对照组( P<0.05)。结论对行颈动脉内膜剥脱术的症状性颈动脉狭窄患者在围术期实施整体护理措施可以有效减轻患者的负性心理,辅助降低并发症的发生率,并加强了护患之间的关系。     

颈动脉经皮血管内成形及支架置入术预防非干预脑动脉系统卒中效果

目的探讨颈动脉颅外段狭窄介入治疗对非干预脑动脉系统卒中二级预防的效果。方法选择在我院住院的213例缺血性卒中并单侧重度颈动脉颅外段狭窄,119例采用自膨式支架经股动脉入路行经皮血管内成形及支架置入术（PTAS）,为介入组;余94例仅接受药物治疗,为药物组。入组时两组一般资料及卒中危险因素、合并其他脑动脉狭窄情况等比较差异均无统计学意义（P〉0．05）。对两组进行为期3年左右随访观察,记录随访期间患者卒中和死亡事件,并进行比较。结果213例中6例失访,其中介入组1例,药物组5例。介入组卒中总复发率、症状性复发率、无症状性复发率及多次复发率均显著低于药物组,差异有统计学意义（P〈0．01,P〈0．05）。介入组PTAS干预的颈动脉系统供血区和非PTAS干预的脑动脉系统供血区的卒中复发率显著低于药物组重度狭窄颈动脉供血区和其他脑动脉供血区（P〈0．01,P〈0．05）。随访期间介入组死亡2例,药物组死亡4例。结论PTAS是治疗颈动脉颅外段狭窄较安全、低创的手段,对颈动脉颅外段重度狭窄患者有显著卒中二级预防效果,不仅体现在开通颈动脉系统供血区,也体现在其他脑动脉系统供血区。     

Carotid artery stenting versus carotid endarterectomy in the treatment of symptomatic and asymptomatic carotid stenosis: a systematic review and meta-analysis

Purpose: To evaluate the short-term and intermediate- to long-term efficacy and safety of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA).Materials and Methods: The published literature was electronically searched for randomized controlled trials (RCTs) between CAS and CEA for the treatment of carotid stenosis performed from January 2000 to January 2017. The short-term and intermediate- to long-term outcomes were evaluated.Results: We identified 10 RCTs including 7,183 participants with symptomatic or asymptomatic carotid stenosis. Our meta-analysis found different results between the patients with and those without symptoms. In patients with symptomatic carotid stenosis, the total stroke incidence in the CAS group was significantly higher than that in the CEA group within the 30-day periprocedural period (p<0.001); however, the myocardial infarction incidence in the CAS group was significantly lower than that in the CEA group (p<0.05). There was no significant difference between the two groups in the mortality within 30 days post-procedure, but the intermediate- to long-term incidence of stroke or death in the CAS group was higher than that of the CEA group (p<0.05). In contrast, for asymptomatic patients, there were no significant differences between the CAS and CEA groups in the short- and intermediate- to long-term outcomes.Conclusion: For patients with symptomatic carotid stenosis, CEA is associated with an increased risk of myocardial infarction, whereas CAS is correlated with an increased risk of procedurally related strokes. However, for patients with asymptomatic carotid stenosis, no significant difference was found in the efficacy or safety between CAS and CEA.     

Short- and long-term outcome after carotid artery stenting with neuroprotection: single-center experience within a prospective registry

BACKGROUND : Carotid artery stenting is an alternative method to surgical endarterectomy for treatment of carotid artery stenosis. METHODS AND RESULTS : Three hundred and seventy-one consecutive patients (71+/-9 years) undergoing 405 carotid artery interventions at a single cardiologic center were studied prospectively within a therapy registry. In general, the interventional procedure was performed using neuroprotective devices to prevent distal embolization. Stents were used routinely whenever possible. Independent neurological assessment took place prior to and after carotid stenting. The neurological event rate was assessed in the early (<30 days) and late post interventional period. In asymptomatic patients, 286 interventions were done with a 30-day stroke rate of 1.3% (ipsilateral 1.0%). In symptomatic patients, strokes occurred in a significantly (p<0.005) higher rate of 5.0% after 119 interventions (all ipsilateral). At long-term follow-up (mean 728+/-548 days) additional strokes occurred ipsilateral to the side of carotid intervention in 0.4% of asymptomatic patients (1.7% of symptomatic patients); contralateral strokes were seen at long-term follow-up in 1.1% of asymptomatic (1.7% of symptomatic) patients. Due to their comorbidities, 1.6% of patients died early, and an additional 11.1% late after carotid stenting. CONCLUSION : Carotid artery stenting with the general use of neuroprotective devices yields acceptable shortterm results with respect to neurological events. Asymptomatic patients have significantly less periprocedural strokes than symptomatic patients. Neurological events during long-term follow-up are rare, in particular ipsilateral to the side of carotid stenting. Thus, carotid artery stenting with neuroprotection is a safe method for carotid revascularization, with acceptable periprocedural events, particularly in asymptomatic patients, and a good long-term neurologic outcome.     

轻中度颈动脉狭窄患者斑块CT血管造影特征

目的 观察轻中度颈动脉狭窄患者高危斑块CT血管造影（CTA）特征及其诊断价值。方法 纳入63例轻中度颈动脉狭窄患者、共81支狭窄动脉,根据临床表现分为有症状组和无症状组。比较组间基本资料;以组内相关系数（ICC）评价观察者间测量结果的一致性,于血管层面比较狭窄动脉斑块特征及CT参数。采用二元Logistic回归模型筛选有症状组与颈动脉狭窄相关的独立危险因素;绘制受试者工作特征（ROC）曲线,并计算曲线下面积（AUC）,评价根据斑块特征及CT参数诊断高危斑块的效能。结果 2组患者性别、年龄及病史差异均无统计学意义（P均>0.05）。观察者测量结果的一致性均较好（ICC均>0.75,P均<0.05）。有症状组血管周围脂肪（PVAT）CT值及斑块强化值均高于无症状组（P均<0.05）,且二者均为有症状颈动脉狭窄的独立危险因素。根据PVAT 的CT值及斑块强化值诊断高危斑块的AUC分别为0.739和0.662,敏感度分别为70.00%和67.50%,特异度分别为80.50%和63.40%。结论 PVAT 的CT值和斑块强化程度可用于识别轻中度颈动脉狭窄患者的高危斑块。     

症状性颈动脉狭窄的血管内支架治疗

目的探讨血管内支架置放术治疗症状性颈动脉狭窄的临床效果。方法对35例颈动脉狭窄>70%的患者行血管内自膨式支架置放术,术中选用保护装置27例,行球囊预扩22例,行后扩5例。结果全部患者操作顺利,共置放支架42枚,影像学评价残余狭窄<20%。临床治愈29例,好转6例。随访1～36个月,症状无复发,无再狭窄。结论血管内支架置放术是治疗症状性颈动脉狭窄的一种有效方法,术后再狭窄有待于长期随访。     

通心络治疗对脑梗死患者颈动脉狭窄程度和超敏C反应蛋白及D-二聚体水平的影响

目的探讨通心络治疗对脑梗死患者颈动脉狭窄程度、超敏C反应蛋白(hs-CRP)和D-二聚体水平的影响。方法选取2014年6月至2015年6月于该院治疗的168例脑梗死患者,按照随机数字表法分为试验组和对照组,各84例。对照组患者接受常规药物治疗,试验组患者在此基础上加用通心络胶囊,以6个月为1个疗程。治疗前及治疗1个疗程后,采用多普勒超声诊断仪检测颈动脉内中膜厚度、粥样斑块面积和颈动脉狭窄率;抽取患者静脉血检测hs-CRP和D-二聚体水平。结果治疗后,2组患者颈动脉内中膜厚度、粥样斑块面积和颈动脉狭窄率均显著减小,但试验组减少更加显著(P0.05)。治疗后,2组患者外周血D-二聚体、hs-CRP水平均显著下降,但试验组患者治疗后D-二聚体、hs-CRP水平更低(P0.05)。结论通心络治疗可有效降低脑梗死患者外周血hs-CRP和D-二聚体水平,延缓颈动脉狭窄,值得推广应用。     

支架植入术在颅外段症状性颈动脉狭窄中的应用

目的:观察支架植入术在颅外段症状性颈动脉狭窄中的临床疗效。方法:回顾性分析行支架植入术的颅外段症状性颈动脉狭窄患者60例的临床资料,评价手术的临床疗效。结果:颈动脉支架60枚全部准确释放,颈动脉狭窄均成功解除;术后残余狭窄率<20%;临床症状消失或好转55例,症状缓解不明显5例;发生一过性心率、血压下降11例,发生高灌注综合症1例,发生TIA1例,经积极治疗均好转;术后30d随访未再发生脑血管事件。结论:颅外段症状性颈动脉狭窄的患者行支架植入术治疗安全、有效。     

Mid-term outcome after carotid artery stenting depends on presence of coronary artery disease

BACKGROUND: Longer-term outcome of patients following carotid artery revascularization depends predominantly on cardiac events rather than neurological events. AIM: To assess the longer-term outcomes of patients with known coronary artery morphology undergoing carotid artery stenting. METHOD: In a prospective observational study including 549 consecutive patients undergoing carotid artery stenting, a coronary angiography was performed in a single session unless a recent angiogram was available. Following the intervention, patients were followed prospectively to determine neurological events as well as major adverse coronary events (MACE) during long-term follow-up. RESULTS: Coronary artery disease was present in 378 patients including 92 patients without current significant stenosis. The MACE rate was 6.4% in patients without coronary artery disease compared to 28.3% in patients with coronary artery disease (P<0.00001). Cardiac and all-cause mortality were statistically significantly higher in patients with a significant coronary stenosis than in patients without coronary artery disease (P<0.001 and P<0.01). Cardiac mortality and all-cause mortality were 2.3% and 7.6% in patients without coronary artery disease (patient group I), 7.6% and 13.0% in patients with coronary artery disease but no current significant stenosis (patient group II), and 10.5% and 16.1% in patients with significant coronary stenosis (patient group III). Neurological events, however, were distributed equally among the three patient groups. CONCLUSIONS: In the longer term, outcomes in patients undergoing carotid artery stenting depend on concomitant coronary artery disease rather than neurological events, cardiac mortality and even all-cause mortality depending on a significant coronary artery stenosis.     

单纯栓塞与支架辅助栓塞治疗颅内动脉瘤的临床效果及安全性分析

目的分析单纯栓塞与支架辅助栓塞治疗颅内动脉瘤的临床效果及安全性。方法选取2016年10月-2018年1月我院收治的86例颅内动脉瘤患者,依据治疗方法的不同均分为观察组(支架辅助栓塞治疗)和对照组(单纯栓塞治疗)。比较两组栓塞效果,术前及术后3、5、7个月改良Rankin量表(modified rankin scale,MRS)评分,治疗后6个月及1年复发率,以及并发症发生情况。结果观察组完全栓塞率为93.02%明显高于对照组完全栓塞率76.74%(P<0.05)。治疗后两组MRS评分随着时间的延长逐渐降低,且相同时间MRS评分观察组明显低于对照组,差异均有统计学意义(P<0.01)。治疗后1年观察组复发率为6.98%明显低于对照组复发率23.26%(P<0.05)。观察组并发症总发生率为34.88%明显高于对照组并发症总发生率11.63%(P<0.05),但两组急性血栓、血管痉挛、缺血性脑卒中、动脉瘤破裂发生率比较差异无统计学意义(P>0.05)。结论与单纯栓塞相比,支架辅助栓塞可提高颅内动脉瘤患者栓塞效果、改善预后并降低复发率,且不会增加出血性及缺血性并发症发生。