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目的探讨颈动脉支架血管成形术(CAS)治疗症状性颅外颈动脉狭窄(SECAS)的早期疗效及新发缺血性脑损害的危险因素,为临床治疗提供参考。方法回顾性分析了47例行CAS治疗的SECAS患者的临床资料,评价早期临床疗效,对支架成形术后新发缺血性脑损害的相关危险因素进行单因素和多因素Logistic回归分析,筛选支架成形术后新发缺血性脑损害的相关危险因素。结果 47例患者48处狭窄全部经CAS治疗,成功率100%;术前平均狭窄程度为(72.7±10.4)%,术后平均狭窄程度为(28.5±11.4)%,两者比较差异有统计学意义(P<0.05);单因素分析表明球扩时球囊移位和术后狭窄程度与新发缺血性脑损害有关;多因素Logistic回归法分析表明,球扩时球囊移位是DWI检出新发缺血性脑损害的危险因素。结论应用CAS治疗SECAS临床疗效显著,患者术后早期狭窄改善明显;球囊预扩时有无发生移位是支架成形术后早期新发缺血性脑损害的独立危险因素,应对球囊预扩时有无发生移位进行重点评估和合理控制,以降低支架成形术后新发缺血性脑损害的发生。
Objective To investigate the early curative effect of carotid stenting angioplasty (CAS) on symptomatic extracranial carotid artery stenosis (SECAS) and the risk factors of new ischemic brain damage, so as to provide a reference for clinical treatment. Methods The clinical data of 47 CASAS-treated patients with SECAS were retrospectively analyzed to evaluate the early clinical efficacy. Single-factor and multivariate Logistic regression analysis were performed on the risk factors associated with new ischemic brain damage after stenting. Relevant risk factors of new ischemic brain damage after. Results Forty-eight cases of 47 patients were all treated with CAS. The success rate was 100%. The average preoperative stenosis was (72.7 ± 10.4)% and the average postoperative stenosis was (28.5 ± 11.4)%. The difference between the two groups was statistically significant (P <0.05). Univariate analysis showed that the ball-shifting and the degree of stenosis after balloon-expansion were related to the new ischemic brain damage. Multivariate Logistic regression analysis showed that the balloon displacement during balloon-expansion was DWI Detection of new risk factors for ischemic brain damage. Conclusions The clinical efficacy of CAS in the treatment of SECAS is significant, and the improvement of early stenosis in patients is obviously improved. Whether there is any shift in pre-dilatation of balloon is an independent risk factor of early ischemic brain injury after stenting. Occurrence of shift when the key assessment and reasonable control to reduce the occurrence of new ischemic brain damage after stenting.