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目的探讨颈动脉内膜剥脱术(CEA)联合颈动脉支架成形术(CAS)治疗颈动脉串联病变的安全性和有效性。方法回顾性分析2013年1月至2014年10月诊治的9例颈动脉串联病变患者资料,男7例,女2例,平均年龄(66.0±4.2)岁;病程2~36个月不等,平均7个月。所有患者均有脑缺血症状,5例存在短暂性脑缺血发作,既往脑梗死2例,伴有冠心病2例,高血压病6例,下肢缺血1例;于充分抗血小板治疗后接受CEA联合CAS术。结果手术技术成功率为100%,术后残余狭窄均小于30%,无围手术期死亡患者。9例患者术前症状均得到改善,无新发脑卒中、脑出血事件。术后2例出现头痛、头晕的脑灌注症状,但出院前均缓解。9例患者随访4~19个月,平均(10.5±6.2)个月,无症状复发,1例术后6个月复查经颅多普勒超声提示颈动脉中度(50%~70%)再狭窄,无死亡患者。结论 CEA联合CAS术治疗颈动脉串联病变是安全和有效的,但仍需更大样本远期随访研究进一步证实。
Objective To investigate the safety and efficacy of carotid endarterectomy (CEA) combined with carotid stenting (CAS) in the treatment of series carotid lesions. Methods The data of 9 patients with carotid atherosclerotic lesions who were diagnosed and treated from January 2013 to October 2014 were retrospectively analyzed. There were 7 males and 2 females, with an average age of (66.0 ± 4.2) years. The duration of disease ranged from 2 to 36 months. An average of 7 months. All patients had symptoms of cerebral ischemia, 5 cases of transient ischemic attack, past cerebral infarction in 2 cases, accompanied by coronary heart disease in 2 cases, 6 cases of hypertension, lower limb ischemia in 1 case; after adequate antiplatelet therapy CEA combined with CAS surgery. Results The success rate of surgical technique was 100%, residual stenosis were less than 30%, no perioperative deaths. All 9 patients had improved preoperative symptoms, no new stroke, cerebral hemorrhage. Postoperative 2 patients had headache, dizziness, cerebral perfusion symptoms, but were relieved before discharge. Nine patients were followed up for 4 to 19 months with an average of (10.5 ± 6.2) months, asymptomatic recurrences and 1 case of 6 months after transcranial Doppler ultrasound suggestive of a moderate carotid artery (50% -70%) Narrow, no death patients. Conclusions The CEA combined with CAS is safe and effective in the treatment of carotid series lesions, but further studies with long-term follow-up are still needed.