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目的通过外科治疗颈动脉颅外段狭窄或闭塞,评价既定推荐策略的合理性。方法将纳入的70例颈动脉颅外段狭窄患者根据既定选择策略分为4组:①仅可行颈动脉内膜剥脱术(CEA)治疗组(必行CEA组,3例)。②仅可行颈动脉支架血管内成形术(CAS)治疗组(必行CAS组,25例)。③同时可行CEA与CAS,选行CEA组,11例。④选行CAS组,31例。另同时期纳入颈动脉颅外段闭塞行颅内外血管搭桥术(EIAB)患者31例为EIAB组。分别观察5组颈动脉狭窄患者的临床预后。结果颈动脉狭窄必行CEA组、必行CAS组以及颈动脉闭塞行EIAB患者的临床预后与既往随机对照临床试验结果相似或稍好;颈动脉狭窄选行CEA组与选行CAS组患者的组间临床预后比较无显著差异。结论只有制定合理的外科治疗方案选择策略,才能实现个体化外科治疗以保证理想的临床预后。
Objective Surgical treatment of extracranial stenosis or occlusion of the carotid artery, evaluate the rationality of the established recommended strategy. Methods 70 patients with extracranial stenosis of carotid artery were divided into 4 groups according to the established selection strategy: ① only carotid endarterectomy (CEA) group (3 cases). ② only feasible carotid stenting angioplasty (CAS) treatment group (necessary CAS group, 25 cases). ③ feasible CEA and CAS, choose the CEA group, 11 cases. ④ selected CAS group, 31 cases. In the same period, 31 patients with intracranial extracranial artery bypass grafting (EIAB) were included in the EIAB group. The clinical outcomes of 5 patients with carotid artery stenosis were observed. Results Carotid stenosis must CEA group, necessary CAS group and carotid artery occlusion patients with EIAB clinical prognosis and previous randomized controlled clinical trial results were similar or slightly better; carotid artery stenosis selected CEA group and selected CAS patients group There was no significant difference between the clinical outcomes. Conclusion Only by formulating a reasonable selection strategy of surgical treatment can individualized surgical treatment be performed to ensure the ideal clinical prognosis.