阿托伐他汀联合阿司匹林和氯吡格雷治疗支架成形术后颈动脉系统短暂性脑缺血发作的研究

目的 观察颈动脉系统短暂性脑缺血发作（TIA）支架成形术后长期联合应用阿托伐他汀钙、阿司匹林肠溶片和氯吡格雷的疗效及安全性.方法 将42例颈动脉支架成形术后的颈动脉系统TIA患者,采用随机数字表法随机分为3组,每组14例,A组应用氯吡格雷75 mg/d,3个月;B组氯吡格雷75 mg/d,6个月;C组氯吡格雷75 mg/d,12个月.3组患者阿司匹林肠溶片100mg/d,阿托伐他汀钙20 mg/次,每晚1次,长期应用.支架成形术后1、3、6及12个月均复查颈动脉超声、经颅多普勒或脑血管造影,比较3组患者主要脑血管病（脑血管性死亡、脑栓塞）及出血等不良事件的发生率.结果 A组有效率为71.4%（10/14）,发生1例与狭窄部位有关的脑栓塞,3例血管再狭窄,无严重出血;B组有效率为100%（14/14）,C组为64.3%（9/14）,B组及C组尚未观察有脑栓塞的发生.C组1例出现上消化道大出血,1例轻度的消化道出血,3例出现皮肤淤斑及牙龈出血.3组患者均未出现明显的肝功能及肌肉的损害.结论 颈动脉系统TIA支架后长期联合应用阿托伐他汀钙、阿司匹林肠溶片和氯吡格雷是安全、有效的,可减少脑血管事件的发生,出血并发症随用药时间的延长亦相应增加.

Research of combined application of lipitor, aspirin and clopidogrel after carotid artery stenting in patients with transient ischemic attack

Objective To observe the efficacy and safety of combined therapy with lipitor, aspirin and clopidogrel after carotid artery stenting in patients with the carotid system transient ischemic attack (TIA). Methods Forty-two cases of carotid artery stenting of the carotid arterial system TIA patients were randomly divided into three groups with 14 cases in each group: the first group with clopidogrel 75 mg/d for 3 months; the second group with clopidogrel 75 mg/d for 6 months and the third group with clopidogrel 75 mg/d for 12 months. Three groups of patients had aspirin 100 mg/d, lipitor 20mg/qn. At 1,3,6 and 12 months after stenting, carotid artery ultrasound,transcranial doppler or DSA was done and major cerebrovascular disease ( cerebral vascular death, cerebral embolism) were then compared. The occurrence rate of major cerebralvascular events and adverse reactions were observed. Results In the first group,1 case had cerebral embolism with the narrow part,3 cases had restenosis. Cerebral embolism was not observed in the second group and the third group. 1 patients had upper gastrointestinal bleeding in the third group. 1 patients had mild gastrointestinal bleeding. 3 cases had skin ecchymosis and bleeding gums.There was no liver function and muscle damage. Conclusions Long-term combined administration of lipitor,aspirin and clopidogrel is safe and effective in carotid artery stenting of TIA. It helps reduce the occurrence of cerebralvascular events after carotid artery stenting operation. But the bleeding complication with the drug also correspondingly increases.