100例连续患者行颈动脉支架置入术并给予脑保护：即刻及两年随访结果

Cernetti Carlo, Reimers Bernhard, Picciolo Amedeo, Saccà Salvatore, Pasquetto Giampaolo, Piccolo Pietro, Favero Luca, Bonanome Andrea, Dell'Olivo Ivano, Pascotto Pietro

Cardiovascular Department, Civic Hospital, Mirano, VE, Italy.

Ital Heart J. 2003 Oct;4(10):695-700.

BACKGROUND

Carotid artery stenting is emerging as an alternative to surgical endarterectomy for the treatment of extracranial carotid artery disease. However, few data are available on the long-term clinical efficacy of carotid artery stenting and on the incidence of restenosis.

METHODS

Stent implantation with the routine use of cerebral protection devices was attempted in a single center experience including 100 consecutive patients (104 lesions) with significant stenosis of the internal carotid artery (mean stenosis 82.8 +/- 9%). The mean age of the patients was 70.8 +/- 14 years, 27 lesions were symptomatic (26.0%) with a lesion related to a previous stroke or transient ischemic attack.

RESULTS

Procedural success was achieved in 103 lesions (99%) and the cerebral protection was successfully applied in 102 procedures (98%). The 30-day incidence of stroke and death was 4% (4 patients). Complications consisted of one major stroke (1%) with persistent ipsilateral amaurosis, two minor strokes (2%), and one (1%) fatal myocardial infarction occurring 4 days after the stent procedure. During follow-up (minimum 24 months; mean 31 +/- 6 months) no further neurological events occurred, 6 patients died of non-neurological causes (6%) and 2 (2%) presented with a non-fatal myocardial infarction. Echo color Doppler scan control (minimum 24 months) was carried out in all surviving patients showing a restenosis classified as moderate (50-69%) in 2 cases and as critical (> or = 70%) in another 2 cases (1.8%). Both critical restenotic lesions were successfully treated by repeating balloon angioplasty.

CONCLUSIONS

The present study demonstrates that carotid artery stenting with routine cerebral protection can be performed with an acceptable procedural complication rate. At the 2-year follow-up carotid artery stenting appeared effective in stroke prevention and durable with a low incidence of restenosis.

背景

对于颅外颈动脉疾病的治疗，颈动脉支架置入术正逐渐成为外科内膜切除术的一种替代方法。然而，关于颈动脉支架置入术的长期临床疗效以及再狭窄发生率的数据却很少。

方法

在一个单中心的经验中，尝试对100例连续的患者（104处病变）进行常规使用脑保护装置的支架植入，这些患者的颈内动脉存在严重狭窄（平均狭窄82.8±9%）。患者的平均年龄为70.8±14岁，27处病变有症状（26.0%），其中一处病变与既往中风或短暂性脑缺血发作有关。

结果

103处病变（99%）手术成功，102例手术（98%）脑保护应用成功。30天内的中风和死亡率为4%（4例患者）。并发症包括1例严重中风（1%）伴有持续性同侧黑矇，2例轻微中风（2%），以及1例（1%）在支架手术后4天发生的致命性心肌梗死。在随访期间（最短24个月；平均31±6个月），未发生进一步的神经系统事件，6例患者死于非神经系统原因（6%），2例（2%）出现非致命性心肌梗死。对所有存活患者进行了超声彩色多普勒扫描对照（最短24个月），结果显示2例患者出现中度再狭窄（50 - 69%），另外2例患者出现严重再狭窄（≥70%）（1.8%）。这两处严重再狭窄病变均通过重复球囊血管成形术成功治疗。