【作者】 夏章勇； 胥庆华； 陈泽涛； 杨华； 杜怡峰；

【Author】 XIA Zhangyong;XU Qinghua;CHEN Zetao;Department of Neurology The People’s Hospital of Liaocheng;

【机构】 浙江省宁波市象山中医医院； 山东省聊城市人民医院神经内科山东省心脑血管病微创治疗工程技术研究中心； 山东省聊城市人民医院干部保健科； 山东中医药大学附属医院干部保健科； 山东省聊城市第三人民医院神经内科； 山东省立医院神经内科；

【摘要】 目的探讨症状性颈动脉完全闭塞患者血管再通术的安全性、有效性及相关影响因素。方法 62例症状性颈动脉完全闭塞患者意向性分为介入组和药物治疗组。介入组21例患者给予颈动脉闭塞血管再通术,药物治疗组41例患者给予阿司匹林、氯吡格雷及他汀类药物治疗。随访主要终点事件为发病2年时功能预后(mRS评分);次要终点事件为血管事件的发生。结果共进行颈内动脉闭塞血管再通术33例,21例成功,手术成功率为63.64%。介入组患者在随访3月、6月、1年及2年时,mRS平均秩次均低于药物组,差异有统计学意义。在随访2年时Logistic回归分析表明,功能预后(mRS)与吸烟(OR=11.680,95%CI 1.174~116.246;P=0.036)、基线NIHSS(OR=25.993,95%CI 1.750~386.009;P=0.018)、介入治疗(OR=0.017,95%CI0.001~0.241;P=0.003)有相关性,其中介入治疗是其独立保护因素。结论对于症状性颈动脉完全闭塞患者血管再通术可能是安全有效的,是患者功能预后的独立保护因素,而吸烟、基线NIHSS不良是其独立危险因素。更多还原

【Abstract】 Objective To explore the safety,efficiency and related influencing factors of vascular recanalization in the patients with symptomatic carotid artery total occlusion.Methods According to patients intention,62 patients with symptomatic carotid artery total occlusion were divided into two groups:antery-intervention therapy group and drug treatment group.In the antery-intervention therapy group,21 patients were given vascular recanalization.In the drug treatment group,41 patients were given aspirin,clopidogrel and statins.The major end-point outcome of follow-up survey was the 2-year functional prognosis evaluated by modified Rankin Score(mRS),while the minor one was the cardiovascular events.Results Total 33 cases were accepted vascular recanalization of carotid artery occlusion.21 cases were successful,and the surgical success rate was 63.64%.For 3 month,6 month,9 month,1 year and 2 year follow up,the antery-intervention therapy group’ s all mRS average ranks were lower than drug treatment group.The differences were statistically significant.For 2 year follow up,Logistic regression analysis showed mRS were related to smoking(OR=11.680,95%CI1.174~116.246;P=0.036),baseline NIHSS(OR=25.993,95%CI1.750~386.009;P=0.018),antery-intervention therapy(OR=0.017,95%CI 0.001-0.241;P=0.003),and antery-intervention therapy was an independent protective factor.Conclusion For patients with with symptomatic carotid artery total occlusion,vascular recanalization may be safe and effective.It is an independent protective factor of functional prognosis in patients,however smoking and poor baseline NIHSS are the independent risk factors.更多还原