颈动脉支架置入术：技术要点
Carotid artery stenting: technical considerations.
作者信息
Vitek J J, Roubin G S, Al-Mubarek N, New G, Iyer S S
机构信息
New York Heart and Vascular Institute at Lenox Hill Hospital, New York, USA.
出版信息
AJNR Am J Neuroradiol. 2000 Oct;21(9):1736-43.
BACKGROUND AND PURPOSE
Carotid endarterectomy (CEA) is one of the most frequently performed operations in the United States. To offer patients a less invasive means to achieve the same goal, carotid artery stenting (CAS) is investigated as an alternative treatment to CEA.
METHODS
Three hundred ninety patients underwent CAS, with 451 vessels treated. CAS was performed using a coaxial system with a 7F 90-cm sheath for predilation, stent placement, and stent dilation. Pretreatment antiplatelet therapy was administered. We currently practice same-day admissions and 23-hour discharges.
RESULTS
The technical success rate was 98%. The 30-day mortality/morbidity rates were as follows: death, 1.7% (two [0.5%] neurologic and five [1.2%] systemic] major strokes, 0.9% (two of four were related to the intervention); minor strokes, 5.5%. Among 25 patients who suffered minor strokes, 14 achieved complete recovery. On an annual basis, the incidence of minor stroke declined from 6.8% (1994-1995), to 5.8% (1995-1996), 5.3% (1996-1997), and then 4% (1997-1998), with no major strokes or neurologic deaths occurring during the 1997 to 1998 period.
CONCLUSION
CAS is an effective treatment for carotid stenosis. With proper selection of patients and meticulous technique, complication rates compare favorably with those of CEA.
背景与目的
颈动脉内膜切除术（CEA）是美国最常开展的手术之一。为给患者提供一种侵入性较小但能达到相同目的的方法，人们对颈动脉支架置入术（CAS）作为CEA的替代治疗方法进行了研究。
方法
390例患者接受了CAS治疗，共治疗451条血管。使用带有7F 90厘米鞘管的同轴系统进行预扩张、支架置入和支架扩张来实施CAS。术前给予抗血小板治疗。我们目前实行当日入院和23小时出院。
结果
技术成功率为98%。30天死亡率/发病率如下：死亡1.7%（2例[0.5%]为神经系统和5例[1.2%]为全身性严重卒中，0.9%（4例中有2例与干预相关）；轻度卒中5.5%。在25例发生轻度卒中的患者中，14例完全康复。每年轻度卒中的发生率从1994 - 1995年的6.8%降至1995 - 1996年的5.8%、1996 - 1997年的5.3%，然后在1997 - 1998年降至4%，在1997至1998年期间未发生严重卒中或神经系统死亡。
结论
CAS是治疗颈动脉狭窄的有效方法。通过恰当选择患者并采用精细技术，其并发症发生率与CEA相比具有优势。
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