李晓

【摘要】目的：通过对颅外脑动脉支架术后单用阿司匹林或氯吡格雷1年的随访，比较两种抗血小板药物的效果。方法：颅外颈动脉症状性狭窄>50%或无症状性狭窄>70%，或症状性后循环颅外段动脉狭窄>50%的患者62例入选，在局麻下行支架置入术，术后均予以双联抗血小板治疗1个月，其后改为单用阿司匹林或氯吡格雷，观察1年内并发症，血管事件及死亡发生情况。结果：随访1年内，阿司匹林组（32例）及氯吡格雷组（30例）均无血管事件发生，并发症（6%对13%）及死亡（0对3%）发生率无明显差异（P>0.05）。结论：颅外脑动脉支架置入术后双联抗血小板治疗1个月后，单用阿司匹林或氯吡格雷口服治疗1年内其并发症、血管事件及死亡发生率无明显差异，值得进行大样本的进一步观察。

【关键词】动脉狭窄；支架置入术；阿司匹林；氯吡格雷

ABSTRACT：Objective：To compare the effect of aspirin or clopidogrel separately after extracranial cerebral artery stenting during one year follow-up. Methods：62 patients with symptomatic extracranial carotid artery stenosis>50% or asymptomatic stenosis>70%，or symptomatic extracranial posterior circulation artery stenosis>50% were selected and performed stenting under local anesthesia，all of them would take dual antiplatelet therapy for one month，and then take aspirin（100mg/d） or clopidogrel（75mg/d） separately，to record complications，vascular events or mortality during one year.Results：There was no vascular events between Aspirin group（32 patients） and Clopidogrel group（30 patients） during one year，and the incidence of complications （6% vs 13%） and mortality（0 vs 3%） had no significant difference between two groups（P>0.05）.Conclusions：There was no significant difference on incidence of complications，vascular events and mortality after taking aspirin or clopidogrel separately for one year after extracranial cerebral artery stenting and subsequently dual antiplatelet therapy for one month，it was worth further observation of large sample.

Key words：Artery stenosis；Stenting；Aspirin；Clopidogrel

脑血管疾病是一种常见病，因其高发病率、高死亡率、高致残率及高复发率，给患者个人及家庭带来了极大的精神压力和经济负担。据统计：脑血管病中有70%～85%为缺血性脑血管病，在幸存者中约3/4患者留下偏瘫等后遗症状[1]。颈动脉内膜剥脱术（carotid endarterectomy，CEA）一直被认为是治疗该项疾病的金标准，但其对手术者技术水平要求较高。颈动脉支架置入術（carotid artery stenting，CAS）虽然开展较CEA晚，但最近的2项大样本随机对照试验（SAPPHIRE及CREST）已证实，CEA和CAS不管在围手术期还是在远期疗效、并发症或不良事件发生率等方面均无明显差异[2，3]。但是关于支架术后的抗血小板药物治疗的许多方面，国内及国际尚缺乏循证医学证据。为此，我们对重庆……