颈动脉支架植入术及药物治疗症状性颈动脉狭窄的临床研究

目的 探讨颈动脉支架植入术在症状性颈动脉狭窄治疗中的安全性、疗效及并发症,并与传统内科药物治疗进行比较. 方法 自2005年5月至2010年5月徐州医学院第二附属医院神经内科共对52例症状性颈动脉狭窄患者行颈动脉支架植入术治疗(支架组),同期63例症状性颈动脉狭窄患者行内科药物治疗(药物组).分别在发病后3个月、6个月、12个月、1年后比较两组患者狭窄血管相关性卒中及短暂性脑缺血发作(TIA)发生率、美国国立卫生院卒中量表神经功能缺损评分(NIHSS). 结果 支架组1例由于路径较差支架无法到位而手术终止；9例术中、术后出现颈动脉窦反射,2例术中出现血管痉挛,4例术中出现高灌注综合征,及时有效处理后均未造成严重后果.随访中,支架组1例手术失败者3个月时卒中复发,余患者12个月内无卒中及TIA事件发作,1年后1例复发；药物组发病后3个月、6个月、12个月、1年后分别有11例、9例、7例及12例卒中或TIA事件发作.支架组发病后3个月、6个月、12个月及1年后NIHSS评分均明显低于药物组,差异有统计学意义(P＜0.05). 结论 颈动脉支架植入术治疗症状性颈动脉狭窄安全、可行,与内科药物治疗相比较能更好地预防卒中复发,值得临床推广应用.

Carotid angioplasty and stenting and medicine in treating patients with symptomatic carotid artery stenosis

Objective To study the safety,efficacy and complications of carotid angioplasty and stenting (CAS) in patients with symptomatic carotid artery stenosis,and compare it with medical therapy.Methods Fifty-two patients with symptomatic carotid artery stenosis,admitted to our hospital from May 2005 to May 2010,were performed CAS,and the other 63 patients with symptomatic carotid artery stenosis admitted to our hospital at the same period were adopted medical therapy.Patients of both groups were followed-up for 3,6 and 12 months,and 1 y; the incidence of ischemic stroke or transient ischemic attack (TIA) were compared and the NIHSS scores were noted between the 2 groups.Results The operation was terminated in 1 patient because of poor operation path; carotid sinus reflex occurred in 9 during intraoperative or postoperative periods; vascular spasm occurred in 2; hyperperfusion syndrome occurred in 4 during intraoperative period,but no serious consequences were noted in patients performed CAS after being given timely and effective treatment.Stroke recurred after 3 months in the patient whose operation was failed; no stroke or TIA recurred in the other patients during the 1-y-follow-up period; and 1 recurred after 1 y in patients received CAS.There are 11,9,7 and 12 patients had stroke or TIA attack during the 3,6 and 12 months,and 1 y follow-up period,respectively,in patients given medical therapy.As compared with those in the patients given medical therapy,the NIHSS scores during the 3,6 and 12 months,and 1 y follow-up period in patients received CAS were significantly lower (P＜0.05).Conclusion The CAS is a safe and feasible method in patients with symptomatic carotid artery stenosis;as compared with medical therapy,it can prevent recurrence of stroke more effectively.