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目的探讨分期介入治疗颈动脉狭窄合并冠心病患者的疗效,并发症及随访效果。方法回顾性分析了57例经冠状动脉及脑血管造影或CT血管成像(CTA)证实的颈动脉狭窄合并冠心病患者的临床资料,所有患者均先行经皮冠状动脉介入治疗(PCI),术后1周左右再行颈动脉支架术(CAS),手术前后均进行水化以保护肾功能,观察手术前后患者的神经功能评分(mRS)、肾功能,术中术后并发症等,对患者进行长期随访,观察有无心肌梗死、脑梗死并复查造影观察支架内情况。结果 57例患者均成功行分期介入手术,技术成功率100%,术中显示血管通畅,狭窄解除满意,手术前后患者mRS评分无明显变化,两次介入前后估算的肾小球滤过率无明显变化,1例患者PCI术后3d出现原脑梗症状加重,紧急行CAS术,预后良好。虽有16例患者存在颈动脉窦反射,但所有患者术后均未出现心肌梗死、脑梗死,无死亡患者。随访期间无一例患者出现心肌梗死及支架侧脑梗死。结论对于颈动脉狭窄合并冠心病患者,分期先行PCI后行CAS是安全有效的治疗方式。
Objective To investigate the efficacy, complications and follow-up of staging interventional therapy in patients with carotid artery stenosis and coronary heart disease. Methods The clinical data of 57 patients with carotid artery stenosis complicated with coronary heart disease confirmed by coronary and cerebral angiography or CT angiography (CTA) were retrospectively analyzed. All patients underwent percutaneous coronary intervention (PCI) Carotid artery stenting (CAS) was performed at about 1 week. Hydration was performed before and after surgery to protect renal function, and neurological function scores (mRS), renal function, intraoperative and postoperative complications were observed before and after surgery. Patients were followed up Long-term follow-up, observe the presence or absence of myocardial infarction, cerebral infarction and review the contrast within the stent. Results All the 57 patients were successfully performed staging and the technical success rate was 100%. The intraoperative vascular smoothness and stenosis were relieved. There was no significant change in the mRS score before and after the operation. The glomerular filtration rate estimated before and after the two interventions was not significant Changes, 1 patient with cerebral infarction symptoms after 3 days of PCI increased, emergency line CAS surgery, the prognosis is good. Although 16 patients had carotid sinus reflex, all patients had no myocardial infarction, cerebral infarction and no death after operation. None of the patients had myocardial infarction or stenting-side cerebral infarction during follow-up. Conclusions For patients with carotid artery stenosis and coronary heart disease, it is safe and effective to treat CAS with advanced PCI.