血管成形术治疗症状性重度颈动脉狭窄的临床研究

目的探讨颈动脉内膜剥脱术(carotid endarterectomy,CEA)和颈动脉支架成形术(carotid artery stenting,CAS)治疗症状性重度颈动脉狭窄的近期和中期临床效果。方法回顾性地分析了2016年1月至2018年12月在我院接受CEA或CAS治疗的203例症状性重度颈动脉狭窄患者的临床资料,分析两种术式的围手术期及中期并发症情况。结果共纳入症状性重度颈动脉狭窄患者203人,分为CAS组(n=132)与CEA组(n=71),术后随访时间为1 y。统计学分析患者在年龄、性别、危险因素、血压等方面均无统计学差异(P>0.05)。围术期并发症分析中显示,CEA组颈部肿胀3例(P=0.017);CAS组30 d内卒中比例明显高于CEA组(P=0.034)。1 y随访结果分析显示,CAS组再狭窄比例明显高于CEA组(P=0.047);在心肌梗死、死亡、脑卒中方面两组间无明显统计学差异。结论CAS与CEA均可安全有效的治疗症状性重度颈动脉狭窄,围术期并发症方面CEA组颈部肿胀明显高于CAS组,CAS组30 d内卒中及1 y再狭窄比例明显高于CEA组。

Treatment of symptomatic severe carotid artery stenosis by angioplasty: clinical trial

Objective To investigate the feasibility and efficacy of carotid endarterectomy and carotid artery stenting in the treatment of symptomatic severe carotid stenosis.Methods Retrospectively analyzed 203 patients with symptomatic severe carotid artery stenosis who received CEA or CAS treatment in Taishan Affiliated Hospital of Shandong First Medical University hospital from January 2016 to December 2018,The postoperative complications,and 1 year follow-up outcomes were recorded.Results A total of 203 patients with symptomatic severe carotid stenosis were included,and they were divided into the CAS group(n=132)and the CEA group(n=71).There were no statistically significant differences in age,gender,risk factors,blood pressure,etc.(P>0.05).In the analysis of perioperative complications,there were 3 cases of neck hematoma in CEA group(P=0.017).The proportion of stroke within 30 days in the CAS group was significantly higher than that in the CEA group(P=0.034).Results Of 1-year follow-up showed that the restenosis rate of CAS group was significantly higher than that of CEA group(P=0.047).There was no significant difference between the two groups in terms of myocardial infarction,death and stroke.Conclusion Both CAS group and CEA group can safely and effectively treat symptomatic severe carotid artery stenosis.In terms of perioperative complications,neck swelling in the CEA group was significantly higher than CAS group,and the proportion of stroke within 30 days and restenosis within 1-year flow up in the CAS group was significantly higher than that in the CEA group.