| 摘要: |
| 目的 探讨颈动脉串联病变患者在急诊血管内治疗同期行颈动脉支架植入的可行性及安全性，以及急诊颈动脉支架植入对患者预后的影响。方法 回顾性连续纳入我科2015年5月至2021年4月收治的符合纳入、排除标准的131例发病24 h内行急诊血管内治疗的颈动脉串联病变患者。根据急诊血管内治疗中是否同期行颈动脉支架植入将患者分为支架植入组（93例）和无支架植入组（38例），比较两组患者基线资料及术后90 d预后良好（改良Rankin量表评分≤2分）率与死亡率、急性期责任血管再闭塞率和症状性颅内出血（sICH）发生率。根据术后90 d预后情况将患者分为预后良好组（67例）及预后不良组（64例），对术后90 d预后的影响因素进行单因素分析，并进一步采用多因素logistic回归分析确定预后良好的独立影响因素。结果 与无支架植入组相比，支架植入组患者年龄较大、罹患糖尿病者占比较高、入院时美国国立卫生研究院卒中量表（NIHSS）评分较低、术后90 d预后良好率较高，差异均有统计学意义（P均< 0.05）；而术后90 d死亡率、术后sICH发生率、责任血管再闭塞率相较无支架植入组差异均无统计学意义（P均>0.05）。与预后不良组相比，预后良好组患者更年轻、入院时NIHSS评分较低、术后C臂CT检查有高密度影的患者占比较低、颅内出血和sICH发生率均较低、支架植入率较高，差异均有统计学意义（P均< 0.05）。多因素logistic回归分析显示，年龄较低（OR=0.931，95%CI 0.886~0.979，P=0.005）、未发生sICH（OR=0.069，95%CI 0.008~0.628，P=0.018）及术后C臂CT检查未见高密度影（OR=0.187，95%CI 0.060~0.589，P=0.004）是急诊行血管内治疗的颈动脉串联病变患者预后良好的独立预测因素，未行支架植入是预后不良的独立预测因素（OR=4.583，95%CI 1.476~14.228，P=0.008）。结论 对于颈动脉串联病变患者，在急诊血管内治疗同期行颈动脉支架植入是安全、可行的，并且急诊颈动脉支架植入是患者预后良好的独立预测因素。 |
| 关键词: 颈动脉串联病变 血管内治疗 颈动脉支架植入 预后 症状性颅内出血 |
| DOI：10.16781/j.0258-879x.2022.01.0072 |
| 投稿时间：2021-09-16 |
| 基金项目: |
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| Carotid artery stenting during procedure of emergency endovascular treatment in patients with carotid artery tandem lesions: a clinical efficacy analysis |
| WU Yan-min,LIN Ding-lai,YI Ting-yu,LIN Xiao-hui,CHEN Rong-cheng,PAN Zhi-nan,ZHENG Xiu-fen,CHEN Wen-huo* |
(Neurovascular Intervention Division, Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian, China
*Corresponding author) |
| Abstract: |
| Objective To explore the feasibility and safety of carotid artery stenting during the procedure of emergency endovascular treatment in patients with carotid artery tandem lesions, and to analyze the effect of emergency carotid artery stenting on prognosis.Methods A total of 131 consecutive patients with carotid artery tandem lesions, who met the inclusion and exclusion criteria and underwent emergency endovascular treatment within 24 h of the onset in our division from May 2015 to Apr. 2021, were retrospectively included. They were divided into stenting group (93 cases) and non-stenting group (38 cases) according to whether undergoing carotid artery stenting during the procedure of emergency endovascular treatment. The baseline data, good prognosis (modified Rankin scale score ≤ 2) rate and mortality 90 d after operation, acute reocclusion rate and incidence of symptomatic intracranial hemorrhage (sICH) were compared between the 2 groups. According to the prognosis 90 d after operation, the patients were divided into good prognosis group (67 cases) and poor prognosis group (64 cases). The influencing factors of prognosis 90 d after operation were analyzed by univariate analysis, and the independent influencing factors of good prognosis were determined by multivariate logistic regression analysis.Results Compared with the non-stenting group, the patients in the stenting group were older, with higher proportion of diabetes mellitus, had a lower National Institutes of Health stroke scale (NIHSS) score on admission and a higher rate of good prognosis 90 d after operation, showing significant differences (all P < 0.05); and there were no significant differences in mortality 90 d after operation, incidence of sICH after operation or reocclusion rate (all P>0.05). Compared with the poor prognosis group, the patients in the good prognosis group were younger, had a lower NIHSS score on admission, fewer hyperdense area on C-arm computed tomography (CT) after operation, lower incidence rates of intracranial hemorrhage and sICH and a higher stenting rate, showing significant differences (all P < 0.05). Multivariate logistic regression analysis showed that younger age (odds ratio[OR]=0.931, 95% confidence interval[CI] 0.886-0.979, P=0.005), no sICH (OR=0.069, 95% 0.008-0.628, P=0.018) and no postoperative hyperdense area on C-arm CT (OR=0.187, 95% CI 0.060-0.589, P=0.004) were independent factors in predicting good prognosis of patients with carotid artery tandem lesions after emergency endovascular treatment, and no stenting was an independent factor in predicting poor prognosis (OR=4.583, 95% CI 1.476-14.228, P=0.008).Conclusion Carotid artery stenting during the procedure of emergency endovascular treatment is safe and feasible in patients with carotid artery tandem lesions. Emergency carotid artery stenting is an independent factor in predicting good prognosis. |
| Key words: carotid artery tandem lesions endovascular treatment carotid artery stent implantation prognosis symptomatic intracranial hemorrhage |
