摘要
目的 探讨颈动脉支架成形术(CAS)后脑血管不良事件的发生情况及其相关影响因素。方法 收集2022年1月至2023年9月于南昌大学第一附属医院就诊的81例颈内动脉颅外段狭窄患者的临床资料,所有患者均接受CAS治疗,末次随访时间为2023年12月,根据随访期间是否发生脑血管不良事件将患者分为发生组(n=14)和未发生组(n=67),比较两组患者的颈动脉狭窄情况、临床特征和相关指标,分析CAS术后发生脑血管不良事件的影响因素。结果 与术前比较,颈内动脉颅外段狭窄患者术后轻度狭窄的比例最高,平均狭窄程度降低,差异均有统计学意义(P﹤0.05)。随访期间,共14例患者发生脑血管不良事件,发生率为17.28%,其中,短暂性脑缺血发作(TIA)5例,脑梗死6例,脑出血2例,血管全因死亡1例。与术前比较,所有患者术后2周、术后1个月及术后3个月的美国国立卫生院卒中量表(NIHSS)和改良Rankin量表(m RS)评分均有所降低,差异均有统计学意义(P﹤0.05)。单因素分析结果显示,发生组患者年龄≥65岁的比例、有糖尿病史的比例、术后残余狭窄的比例、空腹血糖、甘油三酯(TG)水平、低密度脂蛋白胆固醇(LDL-C)水平及NIHSS评分均高于未发生组患者,高密度脂蛋白胆固醇(HDL-C)水平低于未发生组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,年龄≥65岁、有糖尿病史、TG水平、LDL-C水平、NIHSS评分及术后残余狭窄均为颈内动脉颅外段狭窄患者CAS术后发生脑血管不良事件的独立危险因素(P﹤0.05),HDL-C水平是颈内动脉颅外段狭窄患者CAS术后发生脑血管不良事件的保护因素(P﹤0.05)。结论 颈动脉狭窄患者CAS术后发生脑血管不良事件的影响因素较多,包括年龄、糖尿病情况、TG水平、LDL-C水平、NIHSS评分及术后残余狭窄情况。
Objective To investigate the incidence of cerebrovascular adverse events after carotid artery stenting(CAS)and its related influencing factors.Method The clinical data of 81 patients with extracranial stenosis of the internal carotid artery treated in the First Affiliated Hospital of Nanchang University from January 2022 to September 2023 were collected.All patients received CAS treatment.The last follow-up time was December 2023.According to whether cerebrovascular adverse events occurred during the follow-up period,the patients were divided into occurrence group(n=14) and nonoccurrence group(n=67).The carotid artery stenosis,clinical characteristics,and related indicators between two groups of patients were compared,the influencing factors of cerebrovascular adverse events after CAS were analyzed.Result Compared with preoperative results,the patients with extracranial stenosis of the internal carotid artery had the highest proportion of mild stenosis after surgery,and the average degree of stenosis decreased,and the differences were statistically significant(P<0.05).During the follow-up period,a total of 14 patients had cerebrovascular adverse events,the incidence rate was 17.28%,including transient ischemic attack(TIA) in 5 cases,cerebral infarction in 6 cases,cerebral hemorrhage in 2 cases,vascular all-cause death in 1 case.Compared with preoperative results,the National Institutes of health stroke scale(NIHSS) and modified Rankin scale(m RS) scores of all patients decreased at 2 weeks,1 month,and 3 months after surgery,and the differences were statistically significant(P<0.05).The results of single factor analysis showed that the proportion of patients with age≥65 years old,the proportion with history of diabetes,the proportion of postoperative residual stenosis,fasting blood glucose,triglyceride(TG) level,low-density lipoprotein cholesterol(LDL-C) level and NIHSS score in the occurrence group were higher than those in the non-occurrence group,and the high-density lipoprotein cholesterol(HDL-C)level was lower than those in the non occurrence group,with statistical significances(P<0.05).Multivariate analysis showed that age≥65 years old,history of diabetes,TG level,LDL-C level,NIHSS score and postoperative residual stenosis were independent risk factors for cerebrovascular adverse events in patients with extracranial stenosis of the internal carotid artery after CAS(P<0.05),and HDL-C level was a protective factor for cerebrovascular adverse events in patients with extracranial stenosis of the internal carotid artery after CAS(P<0.05).Conclusion There are many influencing factors for cerebrovascular adverse events in patients with extracranial stenosis of the internal carotid artery after CAS,including age,history of diabetes,TG level,LDL-C level,NIHSS score and residual stenosis after CAS.
作者
刘小红
杨珊
李小兵
Liu Xiaohong;Yang Shan;Li Xiaobing(Interventional Radiology Division,the First Affiliated Hospital of Nanchang University,Nanchang 330000,Jiangxi,China;Department of Neurology,the First Affiliated Hospital of Nanchang University,Nanchang 330000,Jiangxi,China)
出处
《血管与腔内血管外科杂志》
2024年第11期1316-1320,1360,共6页
Journal of Vascular and Endovascular Surgery
基金
江西省卫生健康委科技计划(202310324)。
关键词
颈动脉支架成形术
脑血管不良事件
脑梗死
残余狭窄
危险因素
carotid artery stenting
cerebrovascular adverse event
cerebral infarction
residual stenosis
risk factor
作者简介
刘小红,主要从事颈动脉支架等相关的研究,南昌大学第一附属医院;通信作者:杨珊,E-mail:328156227@qq.com。
