腔内治疗颅外颈动脉闭塞性疾病的近期疗效

目的回顾性分析颈动脉成形加支架植入术（CAS）治疗颅外颈动脉闭塞性疾病（ECOD）的近期疗效。方法48条颈动脉接受了CAS。手术进路经股动脉穿刺完成。术后随访分2阶段：≤30d和〉30d。分析病死率和主要的并发症发生率。结果本组男性占91.7％;女性占8．3％,平均年龄（70．6±5.9）岁。术前无脑缺血症状占37．5％,有症状占62．5％。颈动脉内径平均狭窄程度（71．2±14．8）％。术前仅合并1种高危因素的为43．8％;2种或2种以上的47．9％。33．3％的患者对侧颈内动脉内径狭窄≥50％或完全闭塞。CAS的成功率为100％。术后无死亡及明显脑卒中发生。4．2％的患者发生了一过性脑缺血,18．8％的患者发生了颈动脉窦压迫综合征。30d后的随访中,有4．2％的患者出现了〉50％支架内再狭窄;无支架变形发生。结论CAS可用于治疗ECOD,特别对于那些合并有颈动脉内膜切除术高危因素的患者,具有安全、术后致残率和病死率低的优点。

Recent results of carotid stenting for treatment of extracranial carotid occlusive disease

OBJECTIVE: To analyze the recent results of CAS performed by vascular surgeons to treat extracranial carotid occlusive disease (ECOD) retrospectively in a single medical center. METHODS: Forty-eight carotid arteries underwent CAS. Procedures were transfemoral. The postoperative follow-up was separated to 2 periods (30 d). The mortality and all kinds of complications were analyzed. RESULTS: 91.7% of them were men; 8.3% were women; mean age was (70.6 +/- 5.9) years. Preoperative asymptomatic cases were 37.5%; symptomatic cases were 62.5%. Mean internal carotid artery diameter stenosis was (71.2 +/- 14.8)%. 43.8% patients had single preoperative risk factors; two or more of these risk factors were present in 47.9%. In 33.3% cases the contralateral carotid artery had 50% or greater stenosis or was completely occluded. Technical success was achieved in 100%. There were no death, no major or minor stroke but 4.2% TIA. Carotid sinus compression syndrome occurred in 18.8% of patients. At follow-up > 30 days, there had been 4.2% instances of in-stent recurrent stenosis great than 50%, noted by color doppler ultrasound scanning. No stent deformity happened. CONCLUSION: CAS can be preformed safely enough in patients with ECOD at high CEA risk, with lower perioperative morbidity and mortality.