摘要
目的系统分析症状性非急性颈动脉闭塞(symptomatic non-acute carotid artery occlusion,SNACAO)血管内治疗的现状和特点。方法检索PubMed数据库,查找关于“症状性非急性颈动脉闭塞行血管内治疗或者血管内治疗联合颈动脉内膜剥脱术治疗”的所有公开发表的研究,对符合入组标准的文献进行数据整理并汇总分析。结果共纳入15项研究,样本量为437例,其中324例(74.1%)患者成功开通血管,围手术期并发症发生率为14.9%(65例),术后临床不良事件发生率17.2%(75例)。卡方检验分析发现亚洲人群(P=0.049)、闭塞节段短(P=0.007)、有残段(P<0.001)的患者开通率高;低体量组与高体量组相比,围手术期并发症发生率高(P=0.002);有残端(P=0.01)、血管闭塞到开通时间<6 m(P=0.008)的患者术后临床不良事件发生率低(P=0.01)。结论对于SNACAO患者,血管内再通治疗是可行且有效的干预方式。种族人群、年手术量(术者经验)、闭塞长度、有无残段、闭塞时间可能会影响开通手术的成败以及患者的净获益。本文纳入研究的数量和质量有限,结论需进一步验证。
Objective To systematically analysis the status and characters on endovascular therapy(ET)for symptomatic non-acute carotid artery occlusion(SNACAO).Methods Literature search was carried out in PubMed database for articles published in English of“SNACAO treated with ET or ET combined with carotid endarterectomy(CEA)”till April 2019.And then summarize and analyze the data extracted from the researches.Results Fifteen studies were included in this analysis,including 437 patients,and 324(74.1%)were achieved successful recanalization.The results of pooled-analysis demonstrated that the incidence of perioperative complications,restenosis/re-occlusion and postoperative clinical adverse events were 15.1%(66 cases),and 7.3%(18 cases)respectively.Stratified analysis showed that the Asian population(P=0.049),patients with shorter occlusive segmental(P=0.007)and with a stump(P<0.001)had a higher successful recanalization rate.Compared with the high-volume centers,the odds of perioperative complications were higher than the low-volume centers(P=0.002).Patients with stumps(P=0.01),occlusion time<6 months(P=0.008)had a lower incidence of postoperative clinical adverse events(P=0.01).Conclusion For SNACAO,ET should be considered to be a feasible and effective way to relieve the symptoms.Moreover,the kinds of race,annual operation volume,length of occlusion segment,presence of stump and occlusion time may influence the recanalization rate and the net benefit of the patient.The quality of studies included in this study are limited,and the above conclusions need to be to be further verified.
作者
钟曦
佟旭
石光
莫大鹏
王伊龙
ZHONG Xi;TONG Xu;SHI Guang(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中风与神经疾病杂志》
CAS
2019年第12期1068-1073,共6页
Journal of Apoplexy and Nervous Diseases
基金
科技部“十三五”国家重点研发计划(No.2018YFC1312801)
国家自然科学基金委员会杰出青年科学基金项目(No.81825007)
北京高校卓越青年科学家计划项目(No.BJJWZYJH01201910025030)
科技部“十三五”国家重点研发计划“症状性颅内外大动脉狭窄复发进展预测模型与干预策略研究”(No.2017YFC1307900)
北京市科学技术委员会“动脉粥样硬化性颅内动脉狭窄的他汀药物治疗研究”(No.D171100003017001)
北京市优秀人才培养资助青年拔尖团队(No.2016000021223TD03)
关键词
颈动脉
非急性闭塞
血管内治疗
系统分析
Carotid artery
Non-acute occlusion
Endovascular Therapy
Systematic analysis
