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目的通过对颅外颈动脉支架置入术后单用阿司匹林或氯吡格雷1年的随访,比较两种抗血小板聚集药物的效果,并比较不同Essen评分组间两种抗血小板聚集药物的疗效。方法收集2014年1月~2015年1月于重庆医科大学附属第一医院及第三军医大学附属新桥医院接受颅外颈动脉支架置入术的缺血性脑卒中患者219例,术后予以双联抗血小板聚集(阿司匹林100 mg/d及氯吡格雷75 mg/d),应用1个月(69例)或3个月(150例),然后单用阿司匹林(124例)100 mg/d或氯吡格雷(95例)75 mg/d;并对纳入患者进行Essen评分,分为低危组(41例)及高危组(178例);随访1年时的主要终点(同侧脑梗死、非同侧脑梗死、心肌梗死、死亡)及次要终点(颅内或颅外出血)。结果阿司匹林组与氯吡格雷组基线特征均无明显差异。随访1年阿司匹林组主要终点事件同侧脑梗死、非同侧脑梗死、心肌梗死、病死率(分别为2.4%、0.8%、0.8%、0)与氯吡格雷组(分别为1.1%、0、0、0)比较均无明显差异(P>0.05)。阿司匹林组次要终点事件颅内出血、颅外出血发生率(分别为1.6%、3.2%)与氯吡格雷组(分别为1.1%、1.1%)比较亦无明显差异(P>0.05)。Essen评分低危组中阿司匹林组主要终点事件同侧脑梗死、非同侧脑梗死、心肌梗死、病死率(分别为4.3%、0、0、0)与氯吡格雷组(分别为0、0、0、0)比较亦无明显差异(P>0.05);高危组中阿司匹林组主要终点事件同侧脑梗死、非同侧脑梗死、心肌梗死、病死率(分别为2.0%、1.0%、1.0%、0)与氯吡格雷组(分别为1.3%、0、0、0)比较均无明显差异(P>0.05)。结论颅外颈动脉支架置入术后双联抗血小板治疗聚集1或3个月再单用阿司匹林或氯吡格雷抗血小板聚集治疗1年内其主要终点事件及次要终点事件发生率无明显差异;不同Essen评分组间两种抗血小板聚集药物的主要终点事件亦无明显差异。
Objective To compare the effects of two antiplatelet drugs on the extracranial carotid stenting with aspirin or clopidogrel alone for one year and compare the efficacy of two antiplatelet drugs with different Essen scores. Methods A total of 219 patients with ischemic stroke receiving cranial carotid artery stenting were recruited from January 2014 to January 2015 at the First Affiliated Hospital of Chongqing Medical University and the Xinqiao Hospital affiliated to the Third Military Medical University. Double antiplatelet aggregation (aspirin 100 mg / d and clopidogrel 75 mg / d) for 1 month (n = 69) or 3 months (n = 150) followed by aspirin alone Or clopidogrel (95 cases), 75 mg / d. Essen score was included in the patients with low risk group (41 cases) and high risk group (178 cases). The primary end point at 1 year follow-up , Non-ipsilateral cerebral infarction, myocardial infarction, death) and secondary endpoints (intracranial or extracranial hemorrhage). Results There was no significant difference in baseline characteristics between aspirin group and clopidogrel group. The primary endpoint of aspirin 1 year follow-up was ipsilateral cerebral infarction, ipsilateral cerebral infarction, myocardial infarction, and mortality (2.4%, 0.8%, 0.8%, 0 respectively) and clopidogrel group , 0,0) were no significant difference (P> 0.05). In the aspirin group, the incidence of intracranial hemorrhage, extracranial hemorrhage (1.6%, 3.2%, respectively) was not significantly different from that of the clopidogrel group (1.1%, 1.1%, respectively) (P> 0.05). Essen score low-risk group aspirin group The primary endpoint of ipsilateral cerebral infarction, non-ipsilateral cerebral infarction, myocardial infarction, mortality (4.3%, 0,0,0 respectively) and clopidogrel group (0,0 , 0, 0) (P> 0.05). The main endpoints of aspirin group were ipsilateral cerebral infarction, non-ipsilateral cerebral infarction, myocardial infarction and fatality rate (2.0%, 1.0%, 1.0% %, 0) and clopidogrel group (1.3%, 0,0,0 respectively), there was no significant difference (P> 0.05). Conclusions There is no significant difference in the primary end point and the secondary end point within 1 year after the extracranial carotid stenting is treated with double antiplatelet therapy for 1 or 3 months and aspirin alone or clopidogrel alone. There was also no significant difference in the primary endpoint of the two anti-platelet aggregates between different Essen scores.