| Objective:Through retrospective analysis of the treatment outcomes,prognosis and outcomes of the patients with aortic arch superior stenosis in the single center of the first People’s Hospital of Zhangjiagang City,Suzhou(Grade 3b,etc.)from 2012 to 2017,which is a canonical aortic arch superior skull External artery stenosis stent implantation treatment experience.Methods:The clinical data of patients with severe carotid artery,vertebral artery and subclavian artery stenosis in our hospital from March 2012 to August 2017 were collected,and the demographic characteristics and clinical data were retrospectively analyzed.Indices,past medical history,treatment status,perioperative complications,and vascular events during follow-up,the neurological deficit score(NIHSS score)and the modified Rankin scale(m RS score)of the National Institutes of Health were used to assess neurological function at admission and discharge.The outcomes of the prognosis were end point indicators of 3 months,6 months of poor prognosis(m RS≥3 points)and stroke recurrence events after 2 years;comparison of different subgroups(pre-circulatory system Vs post-circulatory system subgroup,symptomatic Vs asymptomatic The clinical characteristics and prognosis of the subgroups,ages <69 years Vs ≥ 69 years old subgroups;and multivariate non-conditional logistic methods were used to establish the clinical outcome prediction models after stent implantation.Results:A total of 132 patients with supra-cranial aortic arch stenting were included.The average NIHSS scores before and after surgery were 3.0 and 2.5,respectively;the preoperative and postoperative residual stenosis rates were 90% and 18%,respectively.Three months and six months of poor prognosis(m RS≥3 points)were 14 cases(10.6%)and 13 cases(9.8%)respectively;9 cases(6.8%)of stroke recurrence events occurred after 2 years.Compared with the 3-month group with good prognosis,patients with poor prognosis showed higher proportion of symptomatic stenosis(P=0.021)and LDL cholesterol≥4.14 mmol/L(P= 0.022).Compared with the 6 months good prognosis group,the patients with poor prognosis had symptomatic stenosis(P=0.042),blood glucose≥7.0 mmol/L(P= 0.053),and LDL cholesterol≥4.14 mmol/L.More(P=0.016).Patients with a 2-year recurrent stroke had a higher prevalence of previous coronary heart disease(P= 0.039),stroke history(P=0.029),and blood glucose≥7.0 mmol/L(P=0.053).In the multivariate analysis,symptomatic stenosis and blood glucose ≥ 7.0 mmol/L were independently associated with poor prognosis for 3 months;symptomatic stenosis,blood glucose≥7.0 mmol/L,low-density lipoprotein cholesterol≥4.14 mmol/L,and 6 months The poor prognosis was still independently related;previous history of coronary heart disease,blood glucose≥7.0 mmol/L was independently associated with stroke recurrence after 2 years.ROC curve results showed that the area under the curve of symptomatic stenosis combined with blood glucose ≥ 7.0 mmol/L(symptomatic stenosis + blood glucose≥7.0 mmol/L)in predicting poor prognosis for 3 months was 0.732;history of previous coronary heart disease + symptomatic stenosis+ The area under the curve of blood glucose ≥ 7.0 mmol/L+low-density lipoprotein cholesterol ≥ 4.14 mmol/L in predicting a 6-month poor prognosis was 0.789;the history of previous coronary heart disease + blood glucose≥7.0 mmol/L predicted a recurrence of stroke after 2 years The area is 0.806.Compared with patients with posterior circulation,the prehypertension history was higher(P=0.001),blood glucose(P=0.031),and postoperative residual stenosis rate(P<0.001),and perioperative safety was higher in patients with posterior circulation.There was no significant difference between the clinical outcomes and the asymptomatic patients.Symptomatic stenting patients had higher rates of admission systolic blood pressure,white blood cell count,perioperative complications,and poor prognosis for 3 months(all P<0.05).There was no difference between the 6-month poor prognosis(P=0.069)and the 2-year recurrent stroke event(P=0.792).Compared with patients <69 years old,patients with≥69 years old had lower triglyceride levels(P=0.045),lower alanine aminotransferase levels(P=0.018),creatinine,and fibrinogen and homocysteine levels.Higher(P=0.004;0.031;0.017),but there was no significant difference in perioperative safety and clinical outcomes.Conclusion:1.Perioperative complications of patients with symptomatic stenosis of the supra-cranial extracranial artery receiving stent implantation are higher than those with asymptomatic stenosis,but the prognosis is good in the long-term(June-2 years);However,there was no difference in perioperative safety and long-term outcome between different stent implantation sites(anterior and posterior circulation)and age(<69 years and ≥69 years)patients.2.Patients with previous history of coronary artery disease,baseline blood glucose ≥7.0mmol/L,low-density lipoprotein≥4.14mmol/L combined with aortic arch superior external cranial artery with moderate-severe stenosis stent implantation,They had a bad prognosis in June and a higher risk of recurrent stroke within 2 years.Therefore,more standardized follow-up and treatment should be given to such patients after the operation. |
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