[1]莫大鹏,张家涌**,张扬,等.高危颈动脉狭窄患者内膜剥脱术和支架术的对比分析[J].中国微创外科杂志,2009,09(3):269-272.
 Mo Dapeng,Zhang Jiayong,Zhang Yang,et al.Comparison of Endarterectomy and Stenting for Highrisk Carotid Atherosclerotic Stenosis[J].Chinese Journal of Minimally Invasive Surgery,2009,09(3):269-272.
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高危颈动脉狭窄患者内膜剥脱术和支架术的对比分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
09
期数:
2009年3期
页码:
269-272
栏目:
出版日期:
2009-08-01

文章信息/Info

Title:
Comparison of Endarterectomy and Stenting for Highrisk Carotid Atherosclerotic Stenosis
作者:
莫大鹏张家涌**张扬李良张彦芳尤玉才鲍圣德
北京大学第一医院神经外科,北京100034
Author(s):
Mo Dapeng Zhang Jiayong Zhang Yang et al.
Department of Neurosurgery, Peking University First Hospital, Beijing 100034, China
关键词:
颈动脉狭窄动脉内膜剥脱术颈动脉支架置入术
Keywords:
Carotid artery stenosisEndarterectomyCarotid artery stenting
分类号:
R654.3
文献标志码:
A
摘要:
目的对比颈动脉内膜剥脱术(carotid endarterectomy,CEA)与颈动脉支架置入术(carotid artery stenting,CAS)在治疗高危颈动脉粥样硬化性狭窄中的作用。方法对58例颈动脉粥样硬化性狭窄患者进行回顾性对照研究。其中32例为CEA组;26例为CAS组。术后30 d、6个月、1年均进行颈部B超、CTA复查或DSA和神经系统检查。初级观察终点设定为术后30 d内发生死亡、卒中事件、心血管不良事件,或随访6个月内的死亡或同侧卒中事件;次级观察终点为与CEA或CAS相关的并发症,或1年内的重度再狭窄。比较2组术后治疗的效果。结果CEA组有3例达到初级观察终点,发生率为94%;CAS组有4例达到初级观察点,累积发生率为154%(χ2=0086,P=0769)。CEA组有4例达到次级观察终点,发生率为125%;CAS组有4例达到次级观察终点,发生率为154%(χ2=0000,P=1000)。结论CAS在治疗高危颈动脉粥样硬化性狭窄时,在安全性和有效性方面与CEA是相同的。
Abstract:
ObjectiveTo compare the efficacy of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for the treatment of highrisk atherosclerotic carotid artery stenosis.MethodsWe retrospectively studied the surgical outcomes of 58 patients with highrisk atherosclerotic carotid artery stenosis. Among the cases, 32 received CEA and 26 underwent CAS. All of the patients were followed up with carotid ultrasonography, CTA or DSA in 30 days, 6 months, and 1 year after the procedures, their neurological function was assessed meanwhile. Cumulative incidence of death, stroke, or myocardial infarction within 30 days after the surgical intervention and death or ipsilateral stroke events between 30 days and 1 year were set as the primary endpoint of the study. And the secondary endpoints were the CEA or CAScorrelated complications or severe restenosis within 1 year after the treatment. The outcomes of the two groups were compared.ResultsThe primary endpoint occurred in 3 patients in the CEA group (94%) and 4 in the CAS group (154%)(χ2=0086, P= 0769 ). And the secondary endpoint was found in 4 of the CEA group (125%) and 4 of the CAS group (154%) respectively (χ2=0000, P=1000).ConclusionsFor the patients with highrisk carotid artery stenosis and coexisting conditions, CEA is as safe and effective as CAS.

参考文献/References:

[1]White H,BodenAlbala B,Wang C,et al.Ischemic stroke subtype incidence among whites,blacks,and Hispanics:The Northern Manhattan Study.Circulation,2005,111:1327-1331.
[2]North American Symptomatic Carotid Endarterectomy Trial Collaborators.Beneficial effect of carotid endarterectomy in symptomatic patients with highgrade carotid stenosis.N Engl J Med,1991,325:445-453.
[3]CARESS Steering Committee.Carotid revascularization using endarterectomy or stenting systems (CARESS):phase I clinical trial.J Endovasc Ther,2003,10:1021-1030.
[4]Yadav JS,Wholey MH,Kuntz RE,et al.Protected carotid artery stenting versus endarterectomy in highrisk patients.N Engl J Med,2004,351:1493-1501.
[5]Hobson RW,Howard VJ,Roubin GS,et al.Carotid artery stenting is associated with increased comp lications in octogenarians:30day stroke and death rates in the CREST leadin phase.J Vasc Surg,2004,40:1106-1111.
[6]Rothwell PM,Eliasziw M,Gutnikov SA,et al.Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis.Lancet,2003,361:107-116.
[7]Halliday A,Mansfield A,Marro J,et al.Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms:Randomised controlled trial.Lancet,2004,363:1491-1502.
[8]Casserly IP,Yadav JS.Carotid intervention.In:Casserly IP,Sachar R,Yadav JS,eds.Manual of peripheral vascular intervention.1st ed. Philadelphia:Lippincott Williams & Wilkins,2005.83-109.
[9]Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS):a randomized trial.Lancet,2001,357:1729-1737.
[10]Carotid endarterectomy for patientswith asymptomatic internal carotid artery stenosis.National Institute of Neurological Disorders and Stroke.J Neurol Sci,1995,129:76-77.

备注/Memo

备注/Memo:
本研究获北京市科委课题资助,课题编号:D090500404013**通讯作者
更新日期/Last Update: 2013-08-19