同期与分期支架成形术治疗老年人双侧颈动脉狭窄的临床对照分析

目的 探讨同期及分期支架成形术治疗老年人双侧颈内动脉严重狭窄的安全性及效果.方法 选择2007年1月至2012年1月接受双侧颈内动脉支架成形术的双侧颈内动脉严重狭窄的老年患者20例,同期手术10例,分期手术10例（间隔1个月）,对其临床治疗进行回顾性分析,观察术中、术后30d临床表现及术后6个月随访疗效.结果 所有患者术中均使用球囊预扩及保护伞,颈内动脉狭窄程度有效改善.同期手术患者术中短暂性脑缺血发作发作2例,8例发生血压、心率一过性下降,分期手术患者术中短暂性脑缺血发作发作2例,血压、心率一过性下降者1例,同期手术患者术后30d内高灌注综合征4例,无卒中发生;分期手术患者术后30d内高灌注综合征1例,3例发生对侧微小脑梗死,1例发生对侧较严重梗死.均无出血、死亡病例.6个月随访同期和分期手术患者各有1例单侧再狭窄50％.结论 双侧颈内动脉严重狭窄同期支架成形术较分期手术术中心率下降风险增加,术后半年无明显差异.

Clinical analysis of simultaneous or staging bilateral carotid stenting for treating old patients with bilateral carotid stenosis

Objective To evaluate the safety and feasibility of simultaneous or staging bilateral carotid stenting for treating old patients with bilateral carotid stenosis.Methods Twenty old patients with bilateral carotid stenosis undergoing bilateral carotid stenting from January 2007 to January 2012 were enrolled in the study,of which 10 received simultaneous surgery and 10 received staged operation （with interval of one month）.The clinical manifestation during operation and 30 days after operation were observed.The curative effect was evaluated after 6 months of follow-up.Results All the patients used balloon preliminary extend and the umbrella protection device,and the operation effectively reduced the internal carotid artery stenosis.In the patients with simultaneous operation,2 patients had transient ischemic attack （TIA） in,8 had a transient drop in blood pressure and heart rate.For the patients with staged operation,3 patients had TIA,one had a transient drop in blood pressure and heart rate.Within 30 days after the surgery,4 patients of simultaneous operation had hyperperfusion syndrome （HS）,and no patient had stroke.One patient of staged operation had HS,3 suffered tiny cerebral infarction,and one occurred side serious infarction.No bleeding,deaths were found.During 6 months of follow-up,the patients of simultaneous operation and staged operation each had 1 case of unilateral restenosis 50%.Conclusion Simultaneous bilateral carotid stenting for treating old patients with bilateral carotid stenos causes increased risk of heart rate decline,with no obvious difference during the follow-up of half a year after treatment.