Zhongguo cuzhong zazhi (Aug 2018)

无症状性颈动脉狭窄患者不同治疗方式后的临床结局 Endovascular Treatment versus Optimal Medical Therapy for Asymptomatic Carotid Artery Stenosis

  • 钟涛，刘东涛，马向科，王剑锋，贾伟华

DOI
https://doi.org/10.3969/j.issn.1673-5765.2018.08.006
Journal volume & issue
Vol. 13, no. 8
pp. 790 – 794

Abstract

Read online

目的 探讨无症状性颈动脉狭窄（asymptomatic carotid artery stenosis，ACAS）患者药物治疗和介入 治疗后的临床结局。 方法 收集北大医疗淄博医院及北京朝阳医院2015年11月-2017年6月接受治疗的102例ACAS患者脑血 管造影诊断及介入或药物治疗的资料，分析介入治疗和单独药物治疗的临床结局及安全性。 结果 102例无症状性颈动脉狭窄患者中，70例患者行颈动脉支架治疗+标准药物治疗，32例拒行支 架成形术或内膜剥脱术的患者给予标准药物治疗。随访1年，治疗组临床终点事件发生率1.4%（1例）， 对照组12.5%（4例），两组临床终点事件发生率比较，差异有统计学意义（χ 2=5.774，P =0.016）。治疗 组中合并易损斑块患者41例，临床终点事件发生率2.4%（1例）；对照组中合并易损斑块患者17例，临 床终点事件发生率17.6%（3例）。治疗组合并易损斑块患者临床终点事件发生率低于对照组合并易 损斑块患者，比较差异有统计学意义（χ 2=4.329，P =0.037）。而本次研究中仅有2例术中出现心绞痛 发作，经及时处理得到改善，无死亡或永久性神经功能缺损病例。 结论 对于ACAS患者和ACAS伴易损斑块患者，颈动脉支架治疗均优于单独标准药物治疗，且有良好 的安全性。 Abstract: Objective To compare the clinical outcome of optimal medical therapy and interventional therapy for patients with asymptomatic carotid artery stenosis (ACAS). Methods 102 patients with ACAS from PKU Care Zibo hospital and Beijing Chao-Yang hospital from November 2015 to June 2017 were included in this study. Data of cerebral angiography, endovascular treatment and medical therapy for all patients were collected. The curative effect and safety of two different treatment methods were compared. Results Of all 102 patients, 70 ones undertook carotid artery stenting combined with standard medical therapy, 32 ones received standard medical therapy. After 1 year follow-up, clinical endpoint events occurred in 1 (1.4%) patient in stenting group, and 4 (12.5%) patients in control group, the difference between the two groups had statistical significance (χ 2=5.774, P =0.016). For high-risk patients with vulnerable carotid plaque, there were 41 ones in stenting group and 17 ones in control group. For such high-risk patients, clinical endpoint events occurred in 1 (2.4%) patient in stenting group and 3 (17.6%) patients in control group, and the difference between the two groups had statistical significance (χ 2=4.329, P =0.037). Two patients had angina during the perioperative period, both of which recovered soon after effective treatment, and no death or permanent neurological deficits occurred. Conclusions For ACAS patients and ACAS patients with vulnerable carotid plaque, carotid artery stenting not only had better curative effect than merely medical therapy, but also had good safety.

Keywords