心脏直视手术前颈动脉支架术的初步探讨

目的 评估心脏疾病合并严重颈动脉狭窄患者于心脏直视手术前行颈动脉支架术预防围手术期缺血性卒中的有效性和安全性.方法 前瞻性队列研究,对心脏疾病合并严重颈动脉狭窄患者于心脏直视手术前行颈动脉支架术,评估颈动脉支架术至心脏直视术后30 d的终点事件(卒中、心肌梗死和死亡).结果 自2005年1月至2007年12月,本研究共连续入选42例患者.颈动脉支架技术成功率100%.远端栓塞防护装置使用率为97.6%(41/42).心脏直视手术包括:冠状动脉旁路移植术36例(85.7%),冠状动脉旁路移植术加瓣膜置换术5例(11.9%),瓣膜置换术1例(2.4%).自颈动脉支架术至心脏直视术后30 d的卒中率为2.4%(1/42),心肌梗死率为0%,死亡率为0%.结论 这一小样本前瞻性队列研究表明,心脏直视手术前行颈动脉支架术预防围手术期缺血性卒中安全有效,优于文献报告的分期颈动脉内膜剥脱术的结果,但由于本研究样本量小,需进一步研究验证.

Outcome of patients with coronary artery disease underwent carotid artery stenting before coronary artery bypass surgery

Objective To evaluate the safety and efficacy of carotid artery stenting before open heart surgery.Methods Patients with heart disease and severe carotid artery stenosis received carotid stenfing before open heart surgery were included in this prospective cohort study.The incidence of stroke,myocardial infarction and death from carotid stenting to 30 days after cardiac surgery was assessed.Results A total of 42 patients were enrolled.The carotid stenfing procedural success rate was 100%.Distal embolic protection devices were used in 97.6% patients (41/42).Thirty-six (85.7%) patients received bypass surgery,5 patients received bypass and valve replacement surgery (11.9%) and 1 patient received valve replacement surgery (2.4%) post carotid stenting.The incidence of stroke,myocardial infarction and death from carotid stenting to 30 days after cardiac surgery was 2.4% (1/42),0% and 0%respectively.Conclusions Our data from this small cohort study showed that carotid artery stenting before open heart surgery was safe and effective for patients with heart disease and severe carotid artery stenosis.