无症状颈动脉粥样硬化斑块内出血与冠状动脉支架植入手术后脑梗塞和死亡的分析

doi:10.3969/j.issn.1009-976X.2020.03.023

摘要/Abstract

摘要： 目的探讨无症状颈动脉狭窄（ACS）患者冠状动脉支架植入手术后并发脑梗塞和死亡的危险因素。方法 110例颈动脉面积狭窄达50%或以上的患者被纳入研究。回顾性分析术前颈动脉粥样硬化斑块内出血（IPH）等因素与术后同侧脑梗塞及死亡率的关系。结果 110例ACS患者中共发生16例IPH（14.5%）,其中有6例IPH（37.5%）和6例（6.4%）分别发生同侧脑梗塞和全因死亡。多变量Cox回归分析显示IPH是同侧脑梗塞和全因死亡率的预测因素（HR：18.47,95%CI：5.14~76.08,P<0.001）和全因死亡率（HR：4.26,95%CI：1.48~11.76,P=0.016）。结论在接受冠状动脉支架植入手术的ACS患者中,IPH与术后脑梗塞和全因死亡率的高风险密切相关。

关键词: 脑梗塞, 无症状颈动脉狭窄, 死亡率

Abstract: Objective To investigate risk factors for postoperative ipsilateral cerebral infarction and all-cause mortality after coronary stent implantation in patients with asymptomatic carotid artery stenosis （ACS）. Methods 110 patients with carotid stenosis of 50% or more were included in the study. The relationship including carotid intraplaque hemorrhage （IPH）, ipsilateral cerebral infarction and all-cause mortality was analyzed retrospectively. Results Sixteen cases of IPH occurred in 110 ACS patients（14.5%）. Six cases of IPH （37.5%） and 6 cases （6.4%） encountered ipsilateral infarction and all-cause mortality, respectively. Multivariate Cox regression analysis showed that IPH was a predictor of ipsilateral cerebral infarction （HR：18.47,95%CI： 5.14~76.08,P<0.001）and all-cause mortality and all-cause mortality （HR：4.26, 95%CI： 1.48~11.76, P=0.016）. Conclusion In patients with ACS undergoing coronary stent implantation, IPH is associated with a high risk of postoperative cerebral infarction and all-cause mortality.

Key words: asymptomatic carotid artery stenosis, all-cause mortality, cerebral infarction

中图分类号:

R651.1

李万春, 高岩升. 无症状颈动脉粥样硬化斑块内出血与冠状动脉支架植入手术后脑梗塞和死亡的分析[J]. 岭南现代临床外科, 2020, 20(03): 367-370.

LI Wan-chun, GAO Yan-sheng. Analysis of risk factor between asymptomatic carotid intraplaque hemorrhage and cerebral infarction and death after coronary stent implantation[J]. Lingnan Modern Clinics in Surgery, 2020, 20(03): 367-370.

参考文献

[1] Axelrod DA, Diwan A, Stanley JC, et al.Cost of routine screening for carotid and lower extremity occlusive disease in patients with abdominal aortic aneurysms[J]. J Vasc Surg, 2002, 35(4): 754-758.
[2] Shishehbor MH, Venkatachalam S, Sun Z, et al.A direct comparison of early and late outcomes with three approaches to carotid revascularization and open heart surgery[J]. J Am Coll Cardiol, 2013, 62(21): 1948-1956.
[3] Nadareishvili ZG, Rothwell PM, Beletsky V, et al.Long-term risk of stroke and other vascular events in patients with asymptomatic carotid artery stenosis[J]. Arch Neurol, 2002, 59(7): 1162-1166.
[4] Nicolaides AN, Kakkos SK, Griffin M, et al.Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study[J]. Eur J Vasc Endovasc Surg, 2005, 30(3): 275-284.
[5] Naylor R, Cuffe RL, Rothwell PM, et al.A systematic review of outcome following synchronous carotid endarterectomy and coronary artery bypass: influence of surgical and patient variables[J]. Eur J Vasc Endovasc Surg, 2003, 26(3): 230-241.
[6] Santarpino G, Nicolini F, De Feo M, et al., Prognostic impact of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting[J]. Eur J Vasc Endovasc Surg, 2018, 56(5): 741-748.
[7] Misaki K, Uno T, Nambu I, et al.symptomatic carotidintraplaquehemorrhage is associated with a high risk of cerebral infarction and death after cardiovascular surgery[J]. J Neurol Sci, 2020, 412: 116801.
[8] Horie N, Morofuji Y, Morikawa M, et al.Communication of inwardly projecting neovessels with the lumen contributes to symptomatic intraplaquehemorrhage in carotid artery stenosis[J]. J Neurosurg, 2015, 123(5): 1125-1132.
[9] Goessens BM, Visseren FL, Kappelle LT, et al.Asymptomatic carotid artery stenosis and the risk of new vascular events in patients with manifest arterial disease: the SMART study[J]. Stroke, 2007, 38(5): 1470-1475.
[10] Gupta A, Baradaran H, Kamel H, et al.Intraplaque high-intensity signal on 3D time-of-flight MR angiography is strongly associated with symptomatic carotid artery stenosis[J]. AJNR Am J Neuroradiol,2014, 35(3): 557-561.
[11] Yamada K, Yoshimura S, Shirakawa M, et al.High intensity signal in the plaque on routine 3D-TOF MRA is associated with ischemic stroke in the patients with low-grade carotid stenosis[J]. J Neurol Sci,2018, 385: 164-167.
[13] Misaki K, Uchiyama N, Mohri M, et al.Prediction of carotid artery in-stent restenosis by quantitative assessment of vulnerable plaque using computed tomography[J]. J Neuroradiol, 2016, 43(1): 18-24.
[14] Chu B, Kampschulte A, Ferguson MS, et al.Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study[J]. Stroke, 2004, 35(5): 1079-1084.
[15] Naylor AR, Bown MJ.Stroke after cardiac surgery and its association with asymptomatic carotid disease: an updated systematic review and meta-analysis[J]. Eur J Vasc Endovasc Surg, 2011, 41(5): 607-624.
[16] Naylor AR, Ricco JB, de Borst GJ, et al. Editor's choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS)[J]. Eu. J Vasc Endovasc Surg, 2018, 55(1): 3-81.
[17] Habib N, Mahmoodi BK, Suttorp MJ, et al.Long-term results of carotid stenting and risk factors in patients with severe carotid artery stenosis undergoing subsequent cardiac surgery[J]. Catheter Cardiovasc Interv, 2019, 93(3): E134-E139.