Cremonesi Alberto, Manetti Raffaella, Setacci Francesco, Setacci Carlo, Castriota Fausto
Interventional Cardio-Angiology Unit, Department of Medical and Surgical Cardiology, Villa Maria Cecilia Hospital, Via Corriera 1, 48010 Cotignola, Italy.
Stroke. 2003 Aug;34(8):1936-41. doi: 10.1161/01.STR.0000081000.23561.61. Epub 2003 Jul 3.
Periprocedural embolization of debris during carotid stenting interventions may result in neurological deficit. This study was designed to evaluate in-hospital and 30-day adverse events in patients percutaneously treated for carotid artery disease with embolic protection devices.
From 1999 to June 2002, a total of 442 consecutive patients underwent percutaneous angioplasty and/or stenting of the extracranial carotid artery. The endovascular procedure was conducted under embolic protection devices.
The percutaneous procedure was successful in 440 of 442 patients (99.5%). No periprocedural death occurred with any embolic protection device. All in-hospital stroke/death and 30-day ipsilateral stroke/death rate was 1.1%. The overall complication rate was 3.4%. Major adverse events included 1 major stroke (0.2%), 4 intracranial hemorrhages (0.9%), 1 carotid artery wall fissuration (0.2%), and 1 diffuse cardioembolism (0.2%). Minor adverse events included 4 minor strokes (0.9%) and 4 transient ischemic attacks (0.9%). The cerebral protection device-related complications were 4 (0.9%): 1 case of abrupt closure of the internal carotid artery because of spiral dissection (0.2%), 1 case of trapped guide wire (0.2%), and 2 cases of intimal dissection (0.5%). Transient loss of consciousness, tremors, and fasciculations were present in 6 of 40 patients (15%) in whom occlusive protection devices were used.
Our data suggest that percutaneous stenting of the carotid artery when a cerebral protection device is used is feasible and effective but not without potential complications. However, a long learning curve may exist for the proper use of some embolic protection devices.
颈动脉支架置入术中操作过程中的碎片栓塞可能导致神经功能缺损。本研究旨在评估使用栓子保护装置经皮治疗颈动脉疾病患者的院内及30天不良事件。
1999年至2002年6月，共有442例连续患者接受了颅外颈动脉的经皮血管成形术和/或支架置入术。血管内手术在栓子保护装置下进行。
442例患者中有440例（99.5%）经皮手术成功。使用任何栓子保护装置均未发生术中死亡。所有院内卒中/死亡及30天同侧卒中/死亡率为1.1%。总体并发症发生率为3.4%。主要不良事件包括1例严重卒中（0.2%）、4例颅内出血（0.9%）、1例颈动脉壁裂伤（0.2%）和1例弥漫性心脏栓塞（0.2%）。次要不良事件包括4例轻度卒中（0.9%）和4例短暂性脑缺血发作（0.9%）。与脑保护装置相关的并发症有4例（0.9%）：1例因螺旋状夹层导致颈内动脉突然闭塞（0.2%）、1例导丝被困（0.2%）和2例内膜夹层（0.5%）。在使用闭塞性保护装置的40例患者中有6例（15%）出现短暂性意识丧失、震颤和肌束颤动。
我们的数据表明，使用脑保护装置时经皮颈动脉支架置入术是可行且有效的，但并非没有潜在并发症。然而，正确使用某些栓子保护装置可能存在较长的学习曲线。
