Reimers Bernhard, Schlüter Michael, Castriota Fausto, Tübler Thilo, Corvaja Nicola, Cernetti Carlo, Manetti Raffaella, Picciolo Amedeo, Liistro Francesco, Di Mario Carlo, Cremonesi Alberto, Schofer Joachim, Colombo Antonio
Cardiology Department, Mirano, Italy.
Am J Med. 2004 Feb 15;116(4):217-22. doi: 10.1016/j.amjmed.2003.09.043.
To evaluate the short-term outcome of patients who underwent carotid stenting with the routine use of cerebral protection devices.
In five centers, 808 successful stent procedures (of 815 attempted) were performed in 753 patients (557 [74%] men; mean [+/- SD] age, 70 +/- 8 years). Cerebral protection involved distal filter devices (n=640), occlusive distal balloons (n=144), or proximal balloon protection (n=24).
The protection device was positioned successfully in 793 (98.2%) of the 808 attempted vessels. Neurologic complications occurred within 30 days after 46 procedures (5.6%), including seven major strokes, 17 minor strokes, and 22 transient ischemic attacks. There were four deaths (one following a major stroke). The 30-day incidence of stroke and death was 3.3% (27/815). The rate of stroke or death was 3.8% (8/213) for symptomatic lesions and 3.2% (19/602) for asymptomatic lesions (P=0.87), and 3.4% (25/729) in patients aged <80 years and 2% (2/86) in those aged > or =80 years (P=0.81). Protection device-related vascular complications, none of which led to neurologic symptoms, occurred after nine procedures (1.1%).
In this uncontrolled study, routine cerebral protection during carotid artery stenting was technically feasible and clinically safe. The incidence of major neurologic complications in this study was lower than in previous reports of carotid artery stenting without cerebral protection.
评估常规使用脑保护装置进行颈动脉支架置入术患者的短期预后。
在五个中心，对753例患者（557例[74%]男性；平均[±标准差]年龄，70±8岁）进行了815次尝试性支架手术，其中808次成功。脑保护措施包括远端滤网装置（n = 640）、闭塞性远端球囊（n = 144）或近端球囊保护（n = 24）。
在808次尝试的血管中，793次（98.2%）成功置入了保护装置。46例手术（5.6%）后30天内发生神经系统并发症，包括7例严重卒中、17例轻度卒中和22例短暂性脑缺血发作。有4例死亡（1例死于严重卒中）。30天时卒中与死亡的发生率为3.3%（27/815）。有症状病变患者的卒中或死亡率为3.8%（8/213），无症状病变患者为3.2%（19/602）（P = 0.87），年龄<80岁患者为3.4%（25/729），年龄≥80岁患者为2%（2/86）（P = 0.81）。9例手术（1.1%）后发生与保护装置相关的血管并发症，均未导致神经系统症状。
在这项非对照研究中，颈动脉支架置入术中常规脑保护在技术上可行且临床安全。本研究中严重神经系统并发症的发生率低于既往未进行脑保护的颈动脉支架置入术报告。
