前循环串联病变患者急诊颈动脉支架置入后支架内再闭塞的影响因素及预后探讨

doi:10.3969/j.issn.1673-5765.2024.08.005

摘要/Abstract

摘要：

目的探讨前循环串联病变患者颈动脉支架置入后支架内再闭塞的可能影响因素及预后情况。

方法回顾性连续收集2020年6月—2022年9月于临沂市人民医院就诊的前循环串联病变且术中接受颈动脉支架置入治疗患者的临床资料，并分析上述患者手术操作过程、血管再通、术后并发症以及预后情况。同时依据90 d功能预后，将患者分为预后良好组与预后不良组，采用多元logistic回归分析影响患者预后的独立危险因素。

结果本研究共纳入111例前循环串联病变且接受急诊颈动脉支架置入治疗的患者，术后有16例（14.4%）患者发生支架内再闭塞。分析发现支架内再闭塞患者术后残余狭窄程度较高且多数患者术前未进行充分的抗栓治疗。同时依据90 d功能预后，将111例患者分为预后良好组（66例）与预后不良组（45例），多元logistic回归分析显示术后支架内再闭塞（OR 0.315，95%CI 0.106～0.932，P=0.037）及术前梗死核心区体积（OR 0.978，95%CI 0.959～0.997，P=0.023）是影响患者预后的独立危险因素。

结论前循环串联病变患者颈动脉支架置入后再闭塞可能与术后残余狭窄程度高、抗栓治疗不充分等因素相关,而术前梗死核心区体积以及支架内再闭塞是影响患者预后的独立危险因素。

文章导读：

在前循环串联病变的缺血性卒中患者中，进行颈动脉支架治疗后，支架内再狭窄可能与术前抗血小板治疗欠缺、术后残余狭窄率高有关。

关键词: 串联病变; 颈动脉支架; 再闭塞

Abstract:

Objective To explore the possible influencing factors and prognosis of in-stent reocclusion of patients with anterior circulation tandem lesions after carotid artery stenting.

Methods Retrospective continuous collection of the clinical data of patients with anterior circulation tandem lesions who underwent carotid artery stenting at Linyi People’s Hospital from June 2020 to September 2022, and analysis of surgical procedures, vascular recanalization, postoperative complications, and prognosis of these patients were performed in this study. Based on the 90-day functional outcome, patients were categorized into favorable and unfavorable prognosis groups, and multivariate logistic regression analysis was employed to identify independent risk factors influencing patient prognosis.

Results This study included 111 patients with anterior circulation tandem lesions who received carotid artery stenting during emergency treatment. Postoperatively, 16 (14.4%) patients experienced in-stent reocclusion. Analysis displayed that patients with in-stent reocclusion had a higher degree of residual stenosis after surgery, and most patients did not receive sufficient antithrombotic therapy before surgery. Based on the 90-day functional prognosis, 111 patients were divided into a good prognosis group (66 cases) and a poor prognosis group (45 cases). Multivariate logistic regression analysis showed that postoperative in-stent reocclusion (OR 0.315, 95%CI 0.106-0.932, P=0.037) and preoperative infarct core volume (OR 0.978, 95%CI 0.959-0.997, P=0.023) were independent risk factors influencing the prognosis of patients.

Conclusions Reocclusion after carotid artery stenting in patients with anterior circulation tandem lesions may be related to factors such as a high degree of postoperative residual stenosis and insufficient preoperative antithrombotic therapy. Preoperative infarct core volume and
in-stent reocclusion are independent risk factors influencing the prognosis of patients.

Key words:

Tandem lesion; Carotid stent; Reocclusion

中图分类号:

王广英, 张琰, 于萍, 刘基, 赵振宇, 王贤军, 孙洪扬, 宫健.

前循环串联病变患者急诊颈动脉支架置入后支架内再闭塞的影响因素及预后探讨 [J]. 中国卒中杂志, 2024, 19(8): 888-894.

WANG Guangying, ZHANG Yan, YU Ping, LIU Ji, ZHAO Zhenyu, WANG Xianjun, SUN Hongyang, GONG Jian.

Exploration of the Influencing Factors and Prognosis of the In-Stent Reocclusion of Patients with Anterior Circulation Tandem Lesions after Carotid Artery Stenting during Emergency Treatment [J]. Chinese Journal of Stroke, 2024, 19(8): 888-894.

参考文献

[1] HEBERT D，ELDER T A，ADEL J G. Emergent carotid endarterectomy and mechanical thrombectomy in tandem occlusion[J/OL]. Surg Neurol Int，2022，13：521[2023-12-12]. https://doi.org/10.25259/SNI_740_2022.

[2] YU M S，MA Y X，REN H C，et al. Emergent management of tandem occlusions in anterior circulation stroke：a single-centre experience[J/OL]. World Neurosurg，2023，170：e491-e499[2023-12-12]. https://doi.org/10.1016/j.wneu.2022.11.040.

[3] OGATA A，SONOBE M，KATO N，et al. Carotid artery stenting without post-stenting balloon dilatation[J]. J Neurointerv Surg，2014，6（7）：517-520.

[4] SANAK D，KOCHER M，ZAPLETALOVA J，et al. Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation：analysis from the METRICS study[J]. J Neurointerv Surg，2023，15（e1）：e123-e128[2023-12-12]. https://doi.org/10.1136/jnis-2022-019176.

[5] 中国卒中学会，中国卒中学会神经介入分会，中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2018[J]. 中国卒中杂志，2018，13（7）：706-729.

Chinese Stroke Association；Chinese Interventional Neuroradiology Society of Chinese Stroke Association；Intervention group of Stroke Prevention and Control Committee，Chinese Prevention Medicine Association. Chinese guidelines for intravascular treatment of acute ischemic stroke 2018[J]. Chin J Stroke，2018，13（7）：706-729.

[6] 张斌升，韩红星，王浩，等. 顺向、逆向开通技术在颈动脉串联闭塞致急性缺血性卒中治疗中的应用对比观察[J]. 山东医药，2019，59（30）：51-53.

ZHANG B S，HAN H X，WANG H，et al. Comparative observation of the application of forward and reverse opening techniques in the treatment of acute ischemic stroke induced by carotid artery tandem occlusion[J]. Shandong Medical Journal，2019，59（30）：51-53.

[7] MAYNAR M，BALDI S，ROSTAGNO R，et al. Carotid stenting without use of balloon angioplasty and distal protection devices：preliminary experience in 100 cases[J]. AJNR Am J Neuroradiol，2007，28（7）：1378-1383.

[8] OBEID T，ARNAOUTAKIS D J，ARHUIDESE I，et al. Poststent ballooning is associated with increased periprocedural stroke and death rate in carotid artery stenting[J/OL]. J Vasc Surg，2015，62（3）：616-623. e1[2023-12-12]. https://doi.org/10.1016/j.jvs.2015.03.069.

[9] RENú A，BLASCO J，LAREDO C，et al. Carotid stent occlusion after emergent stenting in acute ischemic stroke：incidence，predictors and clinical relevance
[J/OL]. Atherosclerosis，2020，313：8-13[2023-12-12]. https://doi.org/10.1016/j.atherosclerosis.2020.09.002.

[10] WALLOCHA M，CHAPOT R，NORDMEYER H，et al. Treatment methods and early neurologic improvement after endovascular treatment of tandem occlusions in acute ischemic stroke[J/OL]. Front Neurol，2019，10：127 [2023-12-12]. https://doi.org/10.3389/fneur.2019.00127.

[11] POP R，HASIU A，MANGIN P H，et al. Postprocedural antiplatelet treatment after emergent carotid stenting in tandem lesions stroke：impact on stent patency beyond day 1[J]. AJNR Am J Neuroradiol，2021，42（5）：921-925.

[12] BESLI F，GUNGOREN F，KOCATURK O，et al. The impact of post-dilatation on periprocedural outcomes during carotid artery stenting：a single-center experience[J/OL]. Atherosclerosis，2019，290：74-79[2023-12-12]. https://doi.org/10.1016/j.atherosclerosis.2019.09.024.

[13] HONG S. Is it time to update the treatment result of extracranial internal carotid artery stenosis？[J]. Ann Palliat Med，2023，12（1）：3-6.

[14] ALLARD J，DELVOYE F，POP R，et al. 24-hour carotid stent patency and outcomes after endovascular therapy：a multicenter study[J]. Stroke，2023，54（1）：124-131.

[15] BRICOUT N，PERSONNIC T，FERRIGNO M，et al. Day 1 extracranial internal carotid artery patency is associated with good outcome after mechanical thrombectomy for tandem occlusion[J]. Stroke，2018，49（10）：2520-2522.

[16] 中国老年2型糖尿病防治临床指南编写组. 中国老年2型糖尿病防治临床指南（2022年版）[J]. 中国糖尿病杂志，2022，30（1）：2-51.

Clinical Guidelines for Prevention and Treatment of Type 2 Diabetes Mellitus in the Elderly in China Writing Group. Clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in China（2022）[J]. Chin J Diabetes，2022，30（1）：2-51.

[17] 段小容，余振球，司晓云，等. 对高血压防治指南的认识[J]. 中华高血压杂志，2022，30（9）：818-823.

DUAN X R，YU Z Q，SI X Y，et al. Understanding of the guidelines for the prevention and treatment of hypertension[J]. Chin J Hypertens，2022，30（9）：818-823.

[18] PAPANAGIOTOU P，GORY B. The challenge of an acute antithrombotic regimen for treatment of tandem lesions stroke[J/OL]. AJNR Am J Neuroradiol，2021，42（5）：926[2023-12-12]. https://doi.org/10.3174/ajnr.A7122.

[19] 蒋芳，赵文博，吉训明. 降低颈动脉支架置入术后缺血性脑损伤措施的研究进展[J]. 中国脑血管病杂志，2020，17（5）：266-271.

JIANG F，ZHAO W B，JI X M. Advances in the measures to reduce ischemic brain injury after carotid artery stenting[J]. Chin J Cerebrovasc Dis，2020，17（5）：266-271.

[20] OKAMOTO T，INOUE Y，OI Y，et al. Strategy of carotid artery stenting as first-line treatment and carotid endarterectomy for carotid artery stenosis：a single-center experience[J/OL]. Surg Neurol Int，2022，13：513[2023-12-12]. https://doi.org/10.25259/SNI_820_2022.

[21] 李中中，苏旭东，刘琳，等. 颈动脉支架置入术后支架内再狭窄研究进展[J]. 中国脑血管病杂志，2021，18（10）：733-736，封3.

LI Z Z，SU X D，LIU L，et al. Research progress of restenosis after carotid stenting[J]. Chin J Cerebrovasc Dis，2021，18（10）：733-736，Cover 3.