颈动脉支架的安全性和有效性

目的评价颈动脉支架植入安全性和有效性。方法前瞻性观察70位中国人所接受的76次颈动脉内膜旋切术 (CEA),对CAS的安全性及有效性做初步探讨。人选者均属高危患者,包括不稳定型心绞痛、同侧CEA史、对侧颈动脉狭窄、颈动脉放疗后狭窄及其他严重的合并症。患者于术前、术后及半年后随访时均接受独立的神经专科检查;于远期随访时复查脑血管造影。结果手术成功率为100％;术前平均狭窄程度达(82±18)％,术后狭窄程度下降至(5±10)％。所有患者共发生3次小卒中(5．7％),均无大卒中事件;住院期间及术后30 d内均无心肌梗死及死亡事件。平均随访期达 (20±12)月;2例患者发生无症状颈动脉再狭窄;2例患者发生非Q波型心肌梗死;两例患者因非神经源性因素死亡;3 例患者发生小卒中;远期随访未发现大卒中。结论在中国人群中,经皮颈动脉支架植入术是安全可行的,它的远期再狭窄率亦低。

Safety and efficacy of carotid artery stenting

OBJECTIVE: To evaluate the safety and efficacy of carotid artery stenting (CAS). METHODS: We prospectively evaluated the safety and efficacy of 76 carotid artery stenting (CAS) procedures in a consecutive series of 70 Chinese patients. This series represented a high-risk group that included patients with unstable angina, previous ipsilateral CEA, contralateral carotid artery occlusion, post-radiation carotid artery stenosis and other severe co-morbid conditions. The patients had independent neurological examinations before and after the procedure and follow-up cerebral angiography at 6 month. RESULTS: The procedural success rate was 100%. The mean carotid artery stenosis was (82+/-18) % before and (5+/-10) % after the procedure. During the initial hospital period and 30 days after CAS, there was no major stroke but 3 minor strokes (5.7%). No myocardial infarctions or deaths occurred during or within 30 days following CAS. At a mean follow-up of 20+/-12 months, 2 patients (2.8%) had asymptomatic restenosis, and 2 non-Q wave myocardial infarction. Death occurred in 2 cases, but none of them was attributed to a neurological cause. Three patients had minor strokes and no major strokes occurred during the follow-up period. CONCLUSION: Percutaneous carotid artery stenting is feasible for performance in Chinese patients and may lower the restenosis rate.