颈段颈动脉支架成形术后发生脑梗死的危险因素研究

Risk Factors of Cerebral Infarction after Cervical Segment Carotid Artery Stenting

摘要: 目的：探讨颈段颈动脉支架成形术后发生脑梗死的相关危险因素。方法：回顾性收集青岛大学附属医院2015年7月至2017年6月采用自膨式支架进行血管成形术治疗颈段颈动脉狭窄患者的临床和影像学相关资料，采用门诊、电话、查阅再次住院病历的方法进行中长期随访，记录支架成形术后发生脑梗死的情况。数据变量应用单因素方差分析，分类数据的比较用X2检验或精确概率计算。采用多因素Logistic逐步回归判断颈段颈动脉支架成形术后发生脑梗死的危险因素。结果：共纳入204例患者，平均年龄66.34 ± 6.85岁，男性166例(81.4%)，女性38例(18.6%)，其中植入开环支架127例，闭环支架41例，混合支架36例。随访时间60个月，其中11例患者出现支架内再狭窄(5.39%)，26例患者术后发生脑梗死(12.7%)，手术同侧脑梗死9例(4.41)%，非同侧脑梗死17例(8.46)%。单因素回归分析显示，吸烟、支架置入术中支架内球囊后扩张、术后支架内再狭窄和术后脑梗死的发生有关，多因素回归分析显示，吸烟和支架置入术中支架内球囊后扩张是术后发生脑梗死的独立危险因素。结论：颈段颈动脉支架成形术的支架类型和术后脑梗死的发生无明显相关性，吸烟和支架置入术中支架内球囊后扩张是术后发生脑梗死的独立危险因素。

Abstract: Objective: To investigate the risk factors associated with cerebral infarction after cervical segment carotid artery stenting (CAS). Methods: Clinical and imaging data of patients with cervical segment cartoid artery stenosis treated with self-expending stent in the affiliated hospital of Qingdao Uni-versity from July 2015 to June 2017 were collected. Medium-and long-term follow-up was conducted by outpatient interviews, reviewing hospital records and via telephone interviews, and the cerebral infarction after CAS events was recorded. Comparisons among continuous variables were made by using one-way ANOVA. Categorical data were tested using X2 test or the Fisher exact test. Multivari-ate Logistic regression analysis was performed to identify the risk factors of cerebral infarction after cervical segment CAS. Results: 204 patients were enrolled in this analysis. The average age is 66.34 ± 6.85, 166 male (81.4%), 38 female (18.6%). 127 patients were implanted with open-loop stents, 41 patients with closed-loop stent, and 36 patients with hybrid stents. Follow-up time was 60 months, 11 patients developed in-stent restenosis (5.39%), 26 patients developed cerebral infarc-tion (12.7%), among them 9 patients were on the same side of operation, 17 patients were not on the same side of operation. Univariate regression analysis showed that smoking and posterior bal-looning after stenting and in-stent restenosis were associated with cerebral infarction after CAS. Multiple regression model showed that the independent risk factors for cerebral infarction after CAS were smoking and posterior ballooning after stenting. Conclusion: Stent type was not associated with cerebral infarction after CAS, the independent risk factors for cerebral infarction after CAS were smoking and posterior ballooning after stenting.