Sabeti Schila, Schillinger Martin, Mlekusch Wolfgang, Nachtmann Tassilo, Lang Wilfried, Ahmadi Ramazanali, Minar Erich
Departments of Angiology and Clinical Neurology, University of Vienna Medical School, Austria.
Radiology. 2004 Jan;230(1):70-6. doi: 10.1148/radiol.2301021371.
To compare neurologic outcome after elective internal carotid artery (ICA) stents have been placed in patients with and in patients without contralateral ICA obstructions.
This study included 471 consecutive patients from a registry database who underwent elective ICA stent placement without cerebral protection for high-grade (greater than 70% stenosis of the ICA, according to the North American Symptomatic Carotid Endarterectomy Trial) symptomatic (n = 147) or asymptomatic (n = 324) ICA stenosis. Contralateral carotid arteries were investigated with angiography. Patients with and patients without contralateral high-grade stenosis (70%-99% stenosis, according to the North American Symptomatic Carotid Endarterectomy Trial) or occlusion were compared with respect to 30-day neurologic outcome by using the chi2 test and multivariate logistic regression analysis.
Neurologic events were observed in 33 patients (7%) with 15 transient ischemic attacks, eight minor strokes, and 10 major strokes that led to death in two patients (combined stroke and death rate, 4%). Eighty-eight patients (19%) with contralateral high-grade ICA stenosis and 43 patients (9%) with contralateral ICA occlusion exhibited a similar rate of postintervention combined neurologic events (n = 9, 7%) compared with patients without contralateral high-grade ICA stenosis or occlusion (n = 24, 7%) (P =.94). No differences were observed between symptomatic and asymptomatic patients. Combined stroke and death rates were also comparable between symptomatic (four of 131, 3%) and asymptomatic (14 of 340, 4%) patients (P =.59). Of all variables tested, multivariate analysis did not detect any predictor for peri- or postinterventional neurologic events.
Contralateral high-grade ICA stenosis or occlusion was not associated with an increased risk for neurologic events after elective ICA stent placement.
比较择期行颈内动脉（ICA）支架置入术的患者中，有或无对侧ICA闭塞患者的神经学转归。
本研究纳入了来自登记数据库的471例连续患者，这些患者因高度（根据北美症状性颈动脉内膜切除术试验，ICA狭窄大于70%）症状性（n = 147）或无症状性（n = 324）ICA狭窄接受了无脑保护的择期ICA支架置入术。对侧颈动脉进行了血管造影检查。根据北美症状性颈动脉内膜切除术试验，将有和无对侧高度狭窄（70%-99%狭窄）或闭塞的患者在30天神经学转归方面进行比较，采用卡方检验和多因素逻辑回归分析。
33例患者（7%）发生神经学事件，其中15例短暂性脑缺血发作，8例轻度卒中，10例重度卒中导致2例患者死亡（卒中合并死亡率为4%）。88例（19%）对侧ICA高度狭窄患者和43例（9%）对侧ICA闭塞患者的干预后合并神经学事件发生率（n = 9，7%）与无对侧ICA高度狭窄或闭塞的患者（n = 24，7%）相似（P = 0.94）。有症状和无症状患者之间未观察到差异。有症状患者（131例中的4例，3%）和无症状患者（34例中的14例，4%）的卒中合并死亡率也相当（P = 0.59）。在所有测试变量中，多因素分析未发现围手术期或干预后神经学事件的任何预测因素。
择期ICA支架置入术后，对侧ICA高度狭窄或闭塞与神经学事件风险增加无关。
