症状性颈动脉狭窄患者介入和药物治疗效果的短期随访

目的:研究症状性颈动脉狭窄(>75%)患者的预后,前瞻性评价介入治疗和药物治疗的效果。方法:51例脑卒中或TIA合并颈动脉狭窄患者意向性分组,分为介入组和药物治疗组。前者20例择期给予颈动脉支架置入术,后者31例给予抗血小板药物及他汀类药物的治疗。随访2年,观察其功能预后(mRS)及脑卒中事件的发生率。结果:两组患者的基线资料(性别、年龄、病史、血压、血脂、NIHSS、mRS)差异无统计学意义。在随访90d,1年,2年时,介入组mRs均低于药物治疗组,且差异具有统计学意义(P<0.05);而1年和2年时脑卒中或TIA的发生率差异存在统计学意义,发病1年时,介入组血管事件5例(5/20),药物治疗组21例(21/31),差异具有统计学意义(χ2=10.53,P=0.01)。在发病2年时,介入组血管事件3例(3/20),药物治疗组19例(19/31),差异具有统计学意义(χ2=9.65,P=0.002)。结论:对于症状性颈动脉狭窄患者,介入治疗较单纯的药物治疗能获得较好的功能预后;介入治疗能减少脑卒中或TIA发病后2年内的发生。

Short-term effects of interventional therapy vs drug on symptomatic carotid artery stenosis

Objective To identify and evaluate the effect of different therapy（interventional therapy ang drug）on symptomatic carotid artery stenosis（75%）prospectively.Method Fifty-one patients with stroke or transient ischemic attack（TIA）suffering from symptomatic carotid artery stenosis were included into this study consectively.They were given intra-artery intervention or united drug therapy.Twenty patients were transplanted with stent,thirty-one patients were given united drug therapy such as antiplatelet,statins drug.The major outcome was the 2-year functional prognosis evaluated by modified Rankin score（mRS）and the cardiovascular events in 1 year,2 years.Results There were no statistical significance of sex,age,medical history,blood pressure,total cholesterol,triglycerde in the two groups at baseline.The modified Rankin score（mRS）of patients who were given intra-artery intervention therapy was lower than the one who were given united drug therapy in 90 d,1 year and 2 years.The incidence of cardiovascular events in 1 year and 2 years after the index stroke or TIA was lower in the intra-artery intervention group than in the united drug therapy（For 1 year＇s follow up,intervention group∶united drug therapy group=5/20∶21/31,χ2=10.53,P=0.01;For 2 years＇ follow up,3/20∶19/31,χ2=9.65,P=0.002）.Conclusion For the stroke or TIA patients suffering from carotid artery stenosis（75%）,intra-artery intervention is superior to pure united drug therapy in achieving better therapeutical effect and reducing the incidence of cardiovascular events after index stroke or TIA.