冠心病合并颈动脉狭窄患者在双联抗血小板治疗期内行颈动脉内膜剥脱手术的安全性
Safety of carotid endarterectomy for the patiets with carotid artery stenosis and coronary artery disease under dual antiplatelet therapy
目的 回顾性分析围手术期使用双联抗血小板治疗冠心病合并颈动脉狭窄患者行颈动脉内膜剥脱手术(CEA)的安全性.方法 回顾分析了2017年1月至2019年3月期间于北京大学国际医院就诊的冠心病颈内动脉狭窄患者,共86例.86例均接受CEA,并在围手术期内持续双联抗血小板治疗.通过评估该组患者围手术期急性冠状动脉综合征(急性ST段抬高性心肌梗死、急性非ST段抬高性心肌梗死和不稳定性心绞痛)发生率、症状性或无症状性缺血性脑血管事件发生率、症状性或无症状性脑出血事件发生率和术后颈部血肿发生率,探讨双联抗血小板治疗冠心病合并颈动脉狭窄患者接受CEA之类的安全性.结果 本组患者中围手术期急性冠状动脉综合征发生率为0,症状性脑梗死发生率为0,无症状性脑梗死发生率为8.1%(7/86);无症状或症状性脑出血发生率为0,颈部血肿发生率为13.9%(13/86).术后30 d随访86例患者的改良RANKIN量表,均<3分,颈部血肿均经保守治疗自行恢复;无神经功能缺损或死亡.结论 冠心病合并颈动脉狭窄患者在接受双联抗血小板治疗的同时行CEA,并未增加围手术期缺血性心脑血管事件的发生率,虽然增加了术区血肿的发生率,但并未明显增加颅内出血事件的发生率,提示,对于冠心病合并颈动脉狭窄患者在双联抗血小板药物治疗期内接受CEA是安全的.
更多Objective To study the safety of dual antiplatelet therapy prior to carotid endarterectomy in the patients with carotid artery stenosis and Coronary Artery Accident. Methods We review 86 patients with carotid artery stenosis and Coronary Artery Accidents who admitted in Peking University International Hospital between 2017 January and 2019 March. The 86 patients undergo carotid endarterectomy with dual antiplatelet therapy. We evaluate the safety of carotid endarterectomy dunring the dual antiplatelet thrapy by analyzing the incidence of acute coronary syndrome, ischemic cerebrovascular accident, intracranial hemorrhage, and regional hematoma. Results From 2017 January to 2019 March, 86 patients with carotid artery stenosis and Coronary Artery Accident continued dual antiplatelet therapy prior to carotid endarterectomy. The incidence of main perioperative complications were as follows:acute coronary syndrome:0; asymptomatic ischemia cerebrovascular accident: 8.1% (7/86); symptomatic ischemia cerebrovascular accident:0;intracranial hemorrhage:0;neck hematoma:13.9%(13/86). All the patients were followed 30 days after the procedure. The modify Rakin Scale of the patients were all <3. The local hematoma were all recovered automatically without treatment and the perioperative mortality and morbidity was 0. Conclusion For the patients with carotid artery stenosis and Coronary Artery Accidents, carotid endarterectomy under dual antiplatelet therapy was a safe choice.
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