颈动脉内膜剥脱术和颈动脉支架的疗效分析

目的回顾分析颈动脉内膜剥脱(carotid endarterectomy,CEA)及颈动脉支架(carotid artery stenting,CAS)治疗颈动脉粥样硬化性狭窄的近期和中期临床效果。方法比较北京协和医院血管外科2010年1月-2014年12月行CEA及CAS患者的临床资料,分析两种术式的安全性及1年内出现再狭窄及再发卒中的情况。结果研究期间共收治颈动脉粥样硬化性狭窄患者572例,其中456例行CEA,116例行CAS。两组患者术前一般资料、临床症状、伴随疾病等因素均无显著性差异。CEA组和CAS组手术相关死亡(0.2%vs 0)、术后30 d内缺血性卒中(1.1%vs 1.7%)、急性心肌梗死(0.7%vs 1.7%)、局部血肿(0.4%vs 0.8%)、植入物感染(0.4%vs 0)、颅外神经损伤(1.1%vs 0)、过度灌注发生率(5.7%vs 3.4%)均无显著差异。CAS组术后持续低血压发生率显著高于CEA组(12.9%vs 1.1%,P0.01)。1年随访结果显示,CAS组出现治疗侧颈动脉再狭窄(﹥50%)显著高于CEA组(6.9%vs 2.6%,P=0.026),但两组术后重度狭窄(﹥70%)(2.5%vs 1.1%)及同侧卒中发生率(0.9%vs 0.4%)上没有显著性差异。结论 CEA和CAS都是治疗颈动脉粥样硬化性狭窄安全有效的措施,但CAS组术后持续低血压及治疗侧颈动脉1年再狭窄发生率高于CEA组。

Efifcacy Analysis of Carotid Endarterectomy and Carotid Artery Stenting

Objective To analyze the early and midterm outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in patients with arteriosclerotic carotid artery stenosis retrospectively. Methods The clinical data were collected and analyzed for the patients with arteriosclerotic carotid stenosis treated with CEA or CAS from January 2010 to December 2014 in Peking Union Medical College Hospital. The rate of periprocedural complication, the restenosis and ipsilateral stroke happened in the ifrst year after the procedure were compared. Results From January 2010 to December 2014, 572 patients with carotid artery stenosis were treated in our institution. Among whom, 456 cases of CEA and 116 cases of CAS were performed. There was no signiifcant difference of the characteristics in the two groups. There was no signiifcant difference in surgery-related death (0.2%vs 0), 30 d ischemic stroke (1.1%vs 1.7%), acute myocardial infarction (0.7%vs 1.7%), wound hematoma (0.4%vs 0.8%), implant infection (0.4%vs 0), cranial nerve damage (1.1%vs 0) and hyperperfusion syndrome (5.7%vs 3.4%) between CEA and CAS, respectively. The ratio of persistent hypotension was signiifcant higher in CAS group (12.9%vs 1.1%, P<0.01). One year follow-up showed that there was more restenosis (>50%) in CAS group (6.9%vs 2.6%,P=0.026), but there was no signiifcant difference in severe restenosis (>70%) (2.5%vs 1.1%) and ipsilateral stroke (0.9%vs 0.4%) between the two groups. Conclusion Both CEA and CAS are safe and effective in the treatment of carotid artery stenosis. However, the ratio of persistent hypotension and restenosis is signiifcant higher in CAS group.