75岁及以上颈部动脉狭窄患者介入治疗的临床观察

目的 观察75岁及以上颈部动脉狭窄患者介入治疗的可行性与临床效果.方法 回顾总结60例年龄≥75岁、接受过介入治疗的颈动脉、椎动脉或近段锁骨下动脉狭窄患者的临床资料,分析其临床表现、影像特点、介入治疗情况和随访结果.结果 60例患者,年龄75～89岁,平均(78.9±3.7)岁;其中93.3%有脑缺血症状,全部病例有内科并存症;同时有2处以上脑动脉狭窄超过30%的患者占91.7%.共有84处狭窄接受介入治疗,置入支架84个,83个成功,技术成功率98.8%;治疗血管术前平均狭窄率(80.8±12.9)%,术后(7.1±9.5)%;术中及术后30 d内并发症发生率8.3%,永久并发症发生率5%;术后症状好转率87.5%.随访5～99个月,平均(36.7±26.3)个月,随访期间脑梗死发生3例,4例死亡(心肌梗死2例,肺癌脑转移1例,脑出血1例);影像随访率78.3%,包括66个支架,再狭窄发生率9.1%,其中椎动脉再狭窄发生率21.7%,颈动脉2.6%,锁骨下动脉0%.结论 75岁及以上颈部动脉狭窄患者接受介入治疗具有较好的临床效果,技术操作可行;但75岁及以上患者常多发血管病变,并存症多,需较高的手术技巧和综合的临床处理.

Interventional treatment of cervical artery stenosis in the elderly patients aged 75 years and over

Objective To investigate the clinical effect and feasibility of interventional treatment of cervical artery stenosis in the elderly patients aged 75 years and over. Methods The data of 60cases aged 75 years or over who underwent interventional treatment of the cervical arteriostenosis involving carotid artery (CA), vertebral artery (VA) or proximal segment of the subclavian artery (SCA) were analyzed retrospectively. The clinical manifestations, imaging characteristics,interventional managements and follow-up results were recorded. Results In this cohort, the mean age was (78. 9±3.7) years (range from 75 to 89). The 50 patients (93.3%) complained of cerebral ischemic symptoms, and all the patients had concurrent diseases or risk factors, including hypertension, diabetes mellitus, coronary heart disease (CHD), stroke history, and so on. Digital subtraction angiography (DSA) data showed 55 cases (91.7%) had 2 or more cerebral arteries with a stenosis exceeding 30%. Among all cases, 84 lesions were treated with 84 stents, with a technical success rate of 98.8%. After stenting, the percent diameter stenosis of lesions decreased from a mean of (80.8 ± 12.9) % to (7.1 ± 9.5 ) %. The periprocedural and 30-day postoperative neurological complication rate was 8. 3 %, resulting in a permanent complication rate of 5 %. Clinical improvement rate was 87.5%. During a follow-up period of (36.7±26. 3) months (range from 5 to 99), there were 4 deaths: 2 died from myocardial infarction, 1 died from brain metastases of lung cancer and 1 died from cerebral hemorrhage. Cerebral infarction recurred in 3 cases. Imaging follow-up in 78. 3% of patients for 66 stents, including ultrasound, CTA, MRA or DSA, showed that the general in-stent restenosis rate was 9. 1%, and the restenosis rate of VA, CA and SCA was 21.7% (5/23), 2.6%and 0, respectively. Conclusions The results of this series suggest that interventional treatment ofcervical artery stenosis in the elderly patients aged 75 years and over is effective and feasible. In our experience, clinical comprehensive management and skillful technique of the operator are equally important for the elderly patients aged 75 years and over with high incidence of concurrent diseases or risk factors.