颈动脉支架成形术中栓子保护装置使用时机的临床分析

发布时间：2018-09-10 07:56

【摘要】：目的： 通过颈动脉高分辨率磁共振扫描,分析颈动脉斑块性质,预测颈动脉支架成形术(Carotid artery stenting, CAS)中病变部位可能脱落的有害栓子。结合患者的危险因素及CAS术中捕捉到的栓子,计算有害栓子发生的概率,为CAS中合理使用栓子保护装置(embolic-protected devices, EPDs)提供可靠依据。 方法：收集2010年10月～2013年12月山东大学附属省立医院行颈动脉支架置入术(Carotid artery stenting, CAS)的患者195名,CAS前行颈动脉高分辨率磁共振扫描,明确颈动脉斑块的性质(稳定斑块或易损斑块),术中所有患者均使用栓子保护装置,术后根据保护装置中捕捉到的斑块的大小、数量将栓子分为A、B、C、D四种类型(A类：保护装置中未见栓子；B类：保护装置中栓子直径2mm,数量上n≤2；C类：保护装置中栓子直径2mm,数量上n≥3；D类：保护装置中栓子直径2mm,数量上n≥1)。根据收集栓子的情况将病人分为两组：无害栓子组(W组：A类和B类)和有害栓子组(Y组：C类和D类)。依次对病人的特征、病史等进行比较分析,得出有害栓子发生的危险因素。根据统计数据,计算易损斑块合并不同数量的危险因素时,有害栓子发生的概率。 结果： 经颈动脉高分辨率MRI检测显示,195例患者中116例为稳定斑块(59.5%),79例为易损斑块(40.5%)。195名患者均成功实施颈动脉支架成形术,术中均使用栓子保护装置。CAS术后Y组包含58名患者,W组包含137名患者。Logistic回归分析显示：年龄(P=0.0465)、狭窄长度(P=0.0475)、吸烟(P=0.0172)以及术前TIA发作≥3次(P=0.0102)均是有害栓子脱落的危险因素。2例(3.4%)有害栓子来自稳定斑块,56例(96.6%)有害栓子来自易损斑块。且当易损斑块合并0项危险因素时,有害栓子的发生率为：44%。当易损斑块合并1项危险因素时,有害栓子的发生率为：68.1%。当易损斑块合并2项危险因素时,有害栓子的发生率为：72.2%。当易损斑块合并3项危险因素时,有害栓子的发生率为：76.5%。当易损斑块合并4项危险因素时,有害栓子的发生率为：84.6%。 结论： 稳定斑块在CAS中有害栓子发生率很低(1.7%)。易损斑块合并越多数量的危险因素,CAS中有害栓子发生率越高。当颈动脉斑块为稳定斑块时,可以考虑不再使用栓子保护装置。当颈动脉斑块为易损斑块时,建议使用栓子保护装置。
[Abstract]:Objective: to analyze the character of carotid plaque by high resolution magnetic resonance imaging (MRI) of carotid artery, and to predict the harmful embolus which may fall off in carotid stent-angioplasty (Carotid artery stenting, CAS). Combined with the risk factors of patients and the embolus captured during CAS operation, the probability of occurrence of harmful emboli was calculated, which provided a reliable basis for the rational use of emboli protection device (embolic-protected devices, EPDs) in CAS. Methods: from October 2010 to December 2013, 195 patients with carotid artery stenting (Carotid artery stenting, CAS) underwent carotid artery high-resolution magnetic resonance imaging (HRMRI) in the Provincial Hospital affiliated to Shandong University. To determine the nature of carotid plaques (stable or vulnerable plaques), all patients were treated with embolus protection devices, and the size of the plaques captured in the protective devices was determined after the operation. The number of emboli was divided into four types: type A: there was no embolus B in the protective device, the diameter of the emboli in the protective device was 2mm, the quantity was n 鈮，

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