虞莉娜+刘进香+席刚明

摘要 目的 分析頸动脉支架成形术（CAS）治疗老年颈内动脉狭窄的疗效、安全性及其相关因素。方法 回顾性纳入2012年1月—2014年6月上海市徐汇区中心医院神经内科收治的152例65岁以上颈内动脉颅外段狭窄患者。分为介入组73例（接受CAS）及对照组79例（接受药物治疗），分组依据患者是否同意接受CAS。对两组患者进行1年随访，观察患者NIHSS及mRS评分变化，比较两组临床疗效。应用logistic回归分析影响65岁以上颈内动脉颅外段狭窄的老年患者进行CAS治疗安全性的相关因素。结果 患者在3、6个月及1年随访时，介入组NIHSS与mRS平均秩次均低于药物组（P<0.05）；治疗30 d后，介入组短暂性脑缺血发作（TIA）发生率较对照组明显下降（P<0.05）；治疗1年后，两组患者脑血管不良事件（TIA、脑梗死、脑出血及血管原因死亡）发生率比较差异无统计学意义（P>0.05）。对介入组进行分析，结果显示，经CAS治疗后发生脑血管不良事件的患者其既往脑梗死史、冠心病、高血压、高脂血症、术前合并非干预脑动脉狭窄，以及术后残余狭窄比例明显高于未发生患者（P<0.05）。多因素logistic分析显示，既往脑梗死史、术前合并非干预脑动脉狭窄及术后残余狭窄，为CAS治疗后脑血管不良事件发生的独立预测因子。结论 CAS治疗老年颈内动脉颅外段狭窄的有效性与安全性高。既往脑梗死史、术前合并非干预脑动脉狭窄及术后残余狭窄是术后脑血管事件发生的危险因素，介入治疗前应加以评估。

关键词：颈内动脉狭窄；颈动脉支架成形术；支架内再狭窄；脑梗死；危险因素

中图分类号：R743.3 文献标志码：A

Carotid artery stent angioplasty for treatment of internal carotid artery stenosis in the elderly： analysis on its efficacy and related factors of safety

YU li-na， LIU jin-xiang， XI gang-ming

Department of Neurology， Shanghai Xuhui Central Hospital， Shanghai 200031， China

Abstract： Objective To study the efficacy and safety of carotid artery stenting（CAS） in elderly patients with internal carotid artery stenosis and its related factors. Methods Between January 2012 and July 2014， a total of 152 patients（over 65 years of age）with carotid artery stenosis were enrolled in this study， of whom 79 patients received drug treatment （control group） and 73 patients received CAS （intervention group）.The two groups were followed up for one year. The patients scores of mRS（the modified Rankin Scale） and NIHSS（ the National Institute of Health Stroke Scale ） were observed and compared in the curative effect between the two groups. By means of logistic regression were analyzed the related safety factors in CAS treatment for elderly patients over 65 with extracranial stenosis of internal carotid artery. Results Both the median mRS （P<0.01） and NIHSS（P<0.05） scores were lower in intervention group than those in control group at 3， 6 and 12 months follow-up， respectively. Thirty days after CAS， there occurred transient ischemic attack （TIA） in intervention group， whose incidence was significantly lower than that in control group （P<0.05）. However， there was no statistical significant difference found between the two groups in the incidence of serious adverse events including TIA， cerebral hemorrhage， cerebral infarction and death（P>0.05）at one year follow-up. And logistic regression analysis showed that the previous history of cerebral infarction， residual stenosis or combined un-interferential cerebral arterial stenosis were all independent predictors of serious adverse events including TIA， cerebral infarction， cerebral hemorrhage， re-stenosis and death （P<0.05）. Conclusion CAS is a safe and effective procedure for old patients with internal carotid artery stenosis. A history of cerebral infarction， combined un-interferential cerebral arterial stenosis or residual stenosis after CAS were all risk factors， which need to be effectively controlled before CAS.

Keywords： intracranial stenosis； carotid artery stenting； re-stenosis； cerebral infarction； risk factor

缺血性脑卒中已成为老年人死亡和致残的主要疾病之一，颈内动脉颅外段狭窄是其发病的主要原因之一。伴颈动脉狭窄的老年卒中患者缺血性卒中复发率通常较高，且预后较差。如何安全有效地干预颈动脉狭窄的问题在临床上备受关注。介入治疗因其创伤性小、安全性高等优势而逐渐成为常用治疗手段，但目前针对介入手段治疗老年颈动脉狭窄的患者预后、安全性及影响因素等的多方面研究尚且存在一定局限性。本研究对颈内动脉颅外段狭窄的老年患者的临床、影像学等资料进行回顾性分析，对比分析颈动脉狭窄的老年患者接受介入治疗及单纯接受药物治疗的疗效、安全性及其相关因素。……