Liu A Y, Paulsen R D, Marcellus M L, Steinberg G K, Marks M P
Department of Radiology, Stanford University School of Medicine, California, USA.
Neurosurgery. 1999 Dec;45(6):1368-73; discussion 1373-4. doi: 10.1097/00006123-199912000-00022.
To assess the long-term outcomes after stent placement for the treatment of carotid artery dissections.
Between 1992 and 1998, seven patients underwent stenting procedures for treatment of extracranial carotid artery dissections resulting from various causes, including trauma (n = 2), iatrogenesis (n = 2), spontaneous development (n = 2), and fibromuscular dysplasia (n = 1). Stenting procedures were performed for large, nonhealing, dissection-induced pseudoaneurysms (four cases) or severe preocclusive stenosis (three cases). A total of 11 stents were placed (Palmaz stents, n = 8; Wallstents, n = 3). Radiological follow-up examinations were performed after a mean period of 17.7 months (range, 1-67 mo), using conventional or computed tomographic angiography. Clinical follow-up data were obtained after a mean period of 42.9 months (range, 13-72 mo).
All stent placements resulted in complete resolution of dissection-induced stenosis. For two of the four patients with aneurysms, the lesions occluded spontaneously at the time of the procedure. The third patient required coil embolization of the pseudoaneurysm. One patient exhibited progressive shrinkage of the aneurysm in serial follow-up examinations, with healing after 18 months. No clinical complications were associated with the procedures. One patient exhibited progression to asymptomatic occlusion 3 months after stenting. The remaining six patients exhibited no significant changes in luminal diameters. All patients remained in clinically stable condition, with no ischemic symptoms, during more than 3.5 years (mean period) of follow-up monitoring.
This experience suggests that stents placed for treatment of extracranial carotid artery dissections remain patent and patients remain free of symptoms on a long-term basis. Additional studies will be required to determine the optimal types of stents and intervals for follow-up monitoring using imaging.
评估支架置入术治疗颈动脉夹层的长期疗效。
1992年至1998年间，7例患者接受了支架置入术，以治疗由各种原因引起的颅外颈动脉夹层，包括创伤（n = 2）、医源性因素（n = 2）、自发形成（n = 2）和纤维肌发育不良（n = 1）。支架置入术用于治疗大型、不愈合的夹层所致假性动脉瘤（4例）或严重的闭塞前狭窄（3例）。共置入11枚支架（Palmaz支架，n = 8；Wallstent支架，n = 3）。平均17.7个月（范围1 - 67个月）后，采用传统血管造影或计算机断层血管造影进行影像学随访检查。平均42.9个月（范围13 - 72个月）后获得临床随访数据。
所有支架置入均使夹层所致狭窄完全消退。4例动脉瘤患者中有2例在手术时病变自发闭塞。第3例患者需要对假性动脉瘤进行弹簧圈栓塞。1例患者在系列随访检查中动脉瘤逐渐缩小，18个月后愈合。手术未出现临床并发症。1例患者在支架置入后3个月进展为无症状性闭塞。其余6例患者管腔直径无明显变化。在超过3.5年（平均时间）的随访监测中，所有患者临床状况保持稳定,无缺血症状。
该经验表明，用于治疗颅外颈动脉夹层的支架长期保持通畅，患者长期无症状。需要进一步研究以确定最佳的支架类型以及影像学随访监测的间隔时间。
