Liu Ya-min, Wang Chong-bao, Qin Hao, Qu Gen-xue, Ma Qiang, Feng Jun, Liu Huan-ling, Sun Han-sheng, He Chao, Zheng Gang
Department of No. 2 Cardiovascular Disease & Peripheral Vascular Disease, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Zhonghua Wai Ke Za Zhi. 2008 Jul 15;46(14):1041-4.
To explore reasonable clinical decision in treating carotid artery stenosis under different conditions.
The data of 133 carotid artery stenosis patients were retrospectively analyzed. Of the patients, 46 cases were treated with carotid angioplasty and stenting (CAS), 87 patients received carotid endarterectomy (CEA). The length of hospital stay and National Institutes of Health Stroke Scale (NIHSS) grade before and after treatment in both groups were observed; the forward flow were assessed by digital subtraction angiography (DSA) before and after treatment; the degree of carotid artery stenosis were determined by using ultrasound during 3 to 24 months after treatment in both groups; the cumulative incidence of major cardiovascular events was concentrated, including appearance of death, stroke or myocardial infarction during 30 days after CAS and CEA and death or homonymy stroke during 31 days to 2 years.
Significant difference was found in hospital stay and when NIHSS exceed 20 after treatment between the two groups (P < 0.05); there was no significant difference in the forward flow before and after treatment in both groups; the carotid artery stenosis had been improved significantly after the operation in both groups; the cumulative incidence of major cardiovascular events in CEA group was significantly higher than in CAS group in 30 days after the operation (P < 0.05), but no statistical difference in 31 days to 2 years after the operation.
CAS and CEA has equivalent effects in treating carotid artery stenosis, and should be selected according to the location of stenosis, etiological factors and the condition of opposite carotid artery.
探讨不同情况下治疗颈动脉狭窄的合理临床决策。
回顾性分析133例颈动脉狭窄患者的数据。其中46例行颈动脉血管成形术及支架置入术（CAS），87例行颈动脉内膜切除术（CEA）。观察两组治疗前后的住院时间及美国国立卫生研究院卒中量表（NIHSS）评分；治疗前后通过数字减影血管造影（DSA）评估前向血流；两组治疗后3至24个月采用超声测定颈动脉狭窄程度；汇总主要心血管事件的累积发生率，包括CAS和CEA术后30天内出现死亡、卒中或心肌梗死以及术后31天至2年内出现死亡或同侧卒中。
两组治疗后的住院时间及治疗后NIHSS评分超过20分时差异有统计学意义（P<0.05）；两组治疗前后的前向血流差异无统计学意义；两组术后颈动脉狭窄均有明显改善；CEA组术后30天内主要心血管事件的累积发生率明显高于CAS组（P<0.05），但术后31天至2年内无统计学差异。
CAS和CEA治疗颈动脉狭窄疗效相当，应根据狭窄部位、病因及对侧颈动脉情况选择。
