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目的探讨颈动脉颅外段狭窄介入治疗对非干预脑动脉系统卒中二级预防的效果。方法选择在我院住院的213例缺血性卒中并单侧重度颈动脉颅外段狭窄,119例采用自膨式支架经股动脉入路行经皮血管内成形及支架置入术(PTAS),为介入组;余94例仅接受药物治疗,为药物组。入组时两组一般资料及卒中危险因素、合并其他脑动脉狭窄情况等比较差异均无统计学意义(P>0.05)。对两组进行为期3年左右随访观察,记录随访期间患者卒中和死亡事件,并进行比较。结果 213例中6例失访,其中介入组1例,药物组5例。介入组卒中总复发率、症状性复发率、无症状性复发率及多次复发率均显著低于药物组,差异有统计学意义(P<0.01,P<0.05)。介入组PTAS干预的颈动脉系统供血区和非PTAS干预的脑动脉系统供血区的卒中复发率显著低于药物组重度狭窄颈动脉供血区和其他脑动脉供血区(P<0.01,P<0.05)。随访期间介入组死亡2例,药物组死亡4例。结论 PTAS是治疗颈动脉颅外段狭窄较安全、低创的手段,对颈动脉颅外段重度狭窄患者有显著卒中二级预防效果,不仅体现在开通颈动脉系统供血区,也体现在其他脑动脉系统供血区。
Objective To investigate the effect of interventional treatment of extracranial carotid stenosis on secondary prevention of stroke in non-intervention cerebral artery system. Methods A total of 213 patients with ischemic stroke and unilateral severe carotid stenosis were enrolled in our hospital. One hundred and nineteen patients with self-expandable stent were treated with percutaneous transluminal angioplasty and stent placement (PTAS) For the intervention group; the remaining 94 cases received only drug treatment, for the drug group. There were no significant differences in the general information of the two groups and the risk factors of stroke when combined with other cerebral arterial stenosis (P> 0.05). The two groups were followed up for about 3 years, and the incidence of stroke and death during follow-up were recorded and compared. Results Of the 213 cases, 6 cases were lost to follow-up, including 1 case of intervention group and 5 cases of drug group. The total relapse rate, symptomatic recurrence rate, asymptomatic recurrence rate and multiple recurrence rate of intervention group were significantly lower than those of drug group, the difference was statistically significant (P <0.01, P <0.05). The recurrent rate of stroke in the blood supply area of the carotid artery and the cerebral artery of the non-PTAS intervention intervention group was significantly lower than that of the severe carotid artery supply area and the other cerebral artery supply area in the drug group (P <0.01, P <0.05) . During the follow-up period, 2 patients died in the intervention group and 4 patients died in the drug group. Conclusions PTAS is a safe and low-invasive method for the treatment of extracranial stenosis of the carotid artery. It has significant secondary prevention of stroke in patients with severe stenosis of extracranial carotid artery. It is not only found in the supply of carotid artery blood supply area but also in other brain Artery system blood supply area.