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目的分析颈动脉支架成形术(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。
Objective To analyze the efficacy, safety and related factors of carotid artery stenting (CAS) in the treatment of elderly patients with internal carotid artery stenosis. Methods Retrospectively enrolled 152 patients with extracranial stenosis of internal carotid artery over 65 years old admitted to Department of Neurology, Shanghai Xuhui Central Hospital from January 2012 to June 2014. Divided into intervention group, 73 cases (receiving CAS) and control group, 79 cases (receiving medical treatment), according to whether patients agree to accept CAS. The two groups of patients were followed up for 1 year, observed NIHSS and mRS score changes, the clinical efficacy of the two groups were compared. Logistic regression analysis was used to analyze the factors related to the safety of CAS in elderly patients with extracranial stenosis of carotid artery over 65 years of age. Results The average rank of NIHSS and mRS in the intervention group was lower than that of the drug group (P <0.05) at 3, 6 months and 1 year follow-up. After TIA for 30 days, TIA occurred in the intervention group The incidence of cerebrovascular adverse events (TIA, cerebral infarction, intracerebral hemorrhage and vascular causes of death) in two groups had no significant difference after one year of treatment (P> 0.05) . Analysis of the intervention group, the results showed that patients with cerebrovascular adverse events after CAS treatment had a history of previous cerebral infarction, coronary heart disease, hypertension, hyperlipidemia, preoperative non-interventional cerebral artery stenosis, and postoperative residual The stenosis ratio was significantly higher than that of no patients (P <0.05). Multivariate logistic analysis showed that previous history of cerebral infarction, preoperative non-interventional cerebral artery stenosis and postoperative residual stenosis were independent predictors of cerebrovascular adverse events after CAS treatment. Conclusions CAS is effective and safe in the treatment of extracranial stenosis of the elderly carotid artery. The history of previous cerebral infarction, preoperative non-interventional cerebral artery stenosis and postoperative residual stenosis are risk factors for postoperative cerebrovascular events and should be evaluated before intervention.