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目的探究在颈动脉分叉部支架成形术中,留置支架的直径与发生血流动力抑制的(Hemodynamic Depression,HD)相关性。方法总结我科104例颈动脉粥样硬化性重度狭窄接受支架成形术的患者,将其分为A、B两组。A组46例,依据传统方法选择支架直径;B组68例选择较小直径支架。比较分析直径、球囊直径与对术后的狭窄率、HD发生率的相关性。结果 104例颈动脉粥样硬化性重度狭窄的患者在行颈动脉支架成形术后,症状都得到改善。A组留置支架直径(9.1±0.3)mm,B组留置的支架直径为(8.3±0.2)mm,两组存在显著差异;A组21名(45.7%)发生HD;B组10名(14.7%)发生HD,两组存在显著差异,留置支架直径较小组HD发生率低。两组球囊直径分别为(4.9±0.2)mm及(4.8±0.1)mm,无显著差异;两组患者支架成形术前狭窄率分别为(76±9)%及(74±8)%,无显著差异;两组患者支架成形术后狭窄率分别为(15±6)%及(17±10)%,无显著差异。A组患者1例出现术后脑血症状,B组患者未出现相关脑缺血症状。Logistis回归分析显示A组(大直径)发生HD的风险是B组(小直径)的4.405倍。结论选用较大支架会更易发生术后HD。与之相比,选用较小直径的支架会减少HD发生率,并且可以使狭窄病变获得相同程度的改善。
Objective To investigate the relationship between the diameter of indwelling stents and the occurrence of hemodynamic depression (HD) during carotid bifurcation stenting. Methods A total of 104 patients with severe carotid atherosclerosis who underwent stenting in our department were divided into A and B groups. A group of 46 patients, according to the traditional method of choice for stent diameter; B group of 68 patients choose a smaller diameter stent. Comparative analysis of diameter, balloon diameter and postoperative stenosis rate, HD incidence correlation. Results In 104 patients with severe carotid atherosclerosis, the symptoms were improved after carotid stenting. In group A, there were 21 (45.7%) HD patients in group A, 10 (14.7%) patients in group B, ) Had HD, there was a significant difference between the two groups, with a smaller diameter of the stent placement HD. There was no significant difference between the two groups (4.9 ± 0.2) mm and (4.8 ± 0.1) mm respectively. The stenosis rates of the two groups were (76 ± 9)% and (74 ± 8)%, respectively There was no significant difference between the two groups. The stenosis rates of the two groups were (15 ± 6)% and (17 ± 10)%, respectively, with no significant difference. One patient in group A had postoperative cerebrovascular symptoms, while those in group B did not show symptoms related to cerebral ischemia. Logistis regression analysis showed that the risk of developing HD in group A (large diameter) was 4.405 times that of group B (small diameter). Conclusions Choosing a larger stent will make postoperative HD more likely. In contrast, the use of stents with smaller diameters reduced the incidence of HD and improved the stenosis to the same extent.