高危颈动脉狭窄患者内膜剥脱术和支架术的对比分析

目的对比颈动脉内膜剥脱术（carotid endarterectomy,CEA）与颈动脉支架置入术（carotid artery stenting,CAS）在治疗高危颈动脉粥样硬化性狭窄中的作用。方法对58例颈动脉粥样硬化性狭窄患者进行回顾性对照研究。其中32例为CEA组;26例为CAS组。术后30d、6个月、1年均进行颈部B超、CTA复查或DSA和神经系统检查。初级观察终点设定为术后30d内发生死亡、卒中事件、心血管不良事件,或随访6个月内的死亡或同侧卒中事件;次级观察终点为与CEA或CAS相关的并发症,或1年内的重度再狭窄。比较2组术后治疗的效果。结果CEA组有3例达到初级观察终点,发生率为9.4%;CAS组有4例达到初级观察点,累积发生率为15.4%（χ2=0.086,P=0.769）。CEA组有4例达到次级观察终点,发生率为12.5%;CAS组有4例达到次级观察终点,发生率为15.4%（χ2=0.000,P=1.000）。结论CAS在治疗高危颈动脉粥样硬化性狭窄时,在安全性和有效性方面与CEA是相同的。

Comparison of Endarterectomy and Stenting for High-risk Carotid Atherosclerotic Stenosis

Objective To compare the efficacy of carotid endarterectomy （CEA） and carotid artery stenting （CAS） for the treatment of high-risk atheroselerotie carotid artery stenosis. Methods We retrospectively studied the surgical outcomes of 58 patients with high-risk atherosclerotie carotid artery stenosis. Among the cases, 32 received CEA and 26 underwent CAS. All of the patients were followed up with carotid ultrasonography, CTA or DSA in 30 days, 6 months, and 1 year after the procedures, their neurological function was assessed meanwhile. Cumulative incidence of death, stroke, or myocardial infarction within 30 days after the surgical intervention and death or ipsilateral stroke events between 30 days and 1 year were set as the primary endpoint of the study. And the secondary endpoints were the CEA or CAS-correlated complications or severe restenosis within 1 year after the treatment. The outcomes of the two groups were compared. Results The primary endpoint occurred in 3 patients in the CEA group （9. 4% ） and 4 in the CAS group （15.4%）（X^2 =0.086, P= 0.769 ）. And the secondary endpoint was found in 4 of theCEA group （12.5%） and 4 of the CAS group （15.4%） respectively （X^2 = 0. 000, P = 1. 000）. Conclusions For the patients with high-risk carotid artery stenosis and coexisting conditions, CEA is as safe and effective as CAS.