颈动脉不同程度狭窄患者支架成形术后并发症的分析

目的比较颈动脉重度狭窄和颈动脉中度狭窄的患者接受支架成形术后并发症的情况。方法回顾性分析46例症状性颈动脉狭窄患者的临床资料，其中颈动脉重度狭窄（狭窄率≥90％）患者16例，颈动脉中度狭窄（50％≤狭窄率〈90％）患者30例。均在局部麻醉下行支架成形术，术中均采用保护装置和自膨式支架。观察支架成形术围手术期和术后3个月内并发症的情况。结果颈动脉中度狭窄患者围手术期出现短暂性心率减慢和血压下降13例，持续低血压5例，颈动脉痉挛6例，共24例次；颈动脉重度狭窄患者出现短暂性心率减慢和血压下降6例，持续低血压7例，颈动脉痉挛8例，高灌注综合钲1例，脑出血1例，共23例次。其中颈动脉重度狭窄患者持续低血压和颈动脉痉挛的发生率高于颈动脉中度狭窄患者，差异有统计学意义，P〈0．05。颈动脉中度狭窄患者术后3个月出现同侧缺血性卒中1例，冠状动脉缺衄事件5例，共6例次；颈动脉重度狭窄患者出现冠状动脉缺血事件3例次，并发症的发生率两组差异无统计学意义，P〉0．05。结论颈动脉重度狭窄患者在支架成形术围手术期的持续低血压和颈动脉痉挛发生率高于颈动脉中度狭窄患者，术后3个月并发症差异无统计学意义。

Analysis of the complications after stent angioplasty in patients with different degrees of carotid stenosis

Objective To compare the complications between the patients with severe carotid artery stenosis （ ≥ 90% ） and those with moderate carotid artery stenosis （50% -90% ）. Methods Forty-six patients with symptomatic carotid artery stenosis were analyzed retrospectively. Of those, 16 patients had severe carotid artery stenosis, and 30 patients had moderate carotid artery stenosis. Stent angioplasty was performed in all the patients under local anesthesia, and both the protective device and self-expanded stent were used during the procedures. The complications of stent angioplasty were observed in the perioperative period and 3 months after the procedures. Results A total of 24 complications occurred in patients with moderate carotid artery stenosis during the perioperative period, including transient decrease of heart rate and blood pressure（ n= 13 ） , sustained hypotension （n = 5） , and carotid artery spasm （n = 6） ; A total of 23 complications occurred in patients with severe carotid artery stenosis, including transient decrease of heart rate and blood pressure（ n = 6） , sustained hypotension （n = 7 ） , and carotid artery spasm （n = 8 ） , hyperpeffusion syndrome （ n = 1 ） , and intraeerebral hemorrhage （n = 1 ）. Of those, the incidence of sustained hypotension and carotid artery spasm in patients with severe carotid artery stenosis were higher than that in patients with moderate carotid artery stenosis. The difference was statistically significant （P 〈 0. 05 ）. A total of 6 complications occurred in patients with moderate carotid artery stenosis, including 1 ipsilateral ischemic stroke and 5 coronary isehemic events 3 months after operation; a total of 3 coronary ischemic events occurred in patients with severe carotid artery stenosis. The complication rate was no statistical difference between the two groups （ P 〉 0.05 ）. Conclusion The incidence of sustained low blood pressure and carotid artery spasm in patients with severe carotid artery stenosis is higher than that in patients with moderate carotid artery stenosis, and there is no statistical difference in complications 3 months after operation.