颈动脉内膜剥脱术治疗颈动脉狭窄支架术后再狭窄的临床研究

Carotid endarterectomy in treatment of restenosis after carotid artery stenting

摘要:

目的??探讨颈动脉内膜剥脱术（CEA）在颈动脉狭窄支架成型术（CAS）后再狭窄治疗缺血性脑 卒中的围术期安全性及近中期效果。方法??回顾性分析 2016 年 1 月—2017 年 12 月湖南中医药大学第一附属 医院 56 例行 CEA 或 CAS 治疗的颈动脉中重度狭窄患者，其中颈动脉狭窄支架术后再狭窄 9 例（治疗组） ， 颈动脉中重度狭窄 47 例（对照组） 。记录两组患者手术切口长度、动脉切开长度、手术时间、血管阻断时间 及围术期相关并发症 ； 随访 6 ～ 30 个月，记录两组患者包括死亡在内的不良反应发生率。结果??两组患者手 术时间、血管阻断时间、围术期并发症及术后近中期效果比较，差异无统计学意义（ P >0.05） ； 治疗组切口 长度及颈动脉切开长度较对照组长（ P <0.05） 。结论??CEA 治疗颈动脉狭窄支架术后再狭窄安全有效。充分 的术前评估、术中电生理监测、娴熟的显微手术技巧及术后管理是提高 CEA 安全性、降低手术风险及并发 症的关键。

Abstract:

Objective To investigate the clinical application of carotid endarterectomy (CEA) in restenosis after carotid artery stenting (CAS). Methods Fifty-six patients with moderate or severe carotid artery stenosis admitted into our hospital from January 2016 to December 2017 were retrospectively analyzed, including 9 patients with restenosis post CAS and 47 patients with moderate or severe carotid artery stenosis. The incision length, arteriotomy length, operation time, blocking time and perioperative complications of the two groups were recorded. Incidence of adverse reactions including death was recorded after 6 months’ follow-up. Results There was no significant difference in operation time, vascular occlusion time, perioperative complications and short-term and mid-term results between the two groups (P > 0.05). Length of incision and carotid artery incision in the restenosis group after CAS was longer than that in the carotid artery stenosis group (P < 0.05). Conclusions CEA is safe and effective in the treatment of restenosis after carotid artery stenting. Sufficient preoperative evaluation, intraoperative electrophysiological monitoring, skilled microsurgical techniques and postoperative management are the keys to improve the safety of CEA.