Kovacic J C, Roy P R, Baron D W, Gunalingam B, Muller D W M
St Vincent's Hospital, Darlinghurst, NSW, Australia.
Intern Med J. 2005 Mar;35(3):143-50. doi: 10.1111/j.1445-5994.2004.00756.x.
Carotid stenting was initially proposed as an alternative to surgical endarterectomy for selected high-risk patients. More recently, patients of standard surgical risk are being considered for percutaneous treatment of their carotid disease.
To describe the clinical outcomes of an initial consecutive cohort of patients treated by carotid stenting at one institution.
Between December 1997 and July 2003, 111 patients underwent stenting of 118 carotid arteries. Peri-procedural and long-term outcome data were collected.
Most patients (>70%) were high-risk candidates for endarterectomy. Stents were successfully placed in 117/118 carotid arteries (99.2%). Distal protection devices were used in 43/118 (36.4%). The peri-procedural rate of death or disabling stroke was 3/118 (2.5%). Death or any stroke occurred in 11/118 (9.3%). However, only 7/118 (5.9%) procedures resulted in death or any persistent stroke (neurological deficit >1 week post-procedure). No myocardial infarction occurred. Median length of post-procedure hospitalization was 1 day. Long-term follow up was possible for 101 patients (91.0%) over a mean period of 27.1 months. The Kaplan-Meier estimate of survival free of ipsilateral stroke 36 and 66 months after carotid stenting was 77.0 +/- 9.5% and 68.2 +/- 15.1%, respectively. The estimated survival free of any stroke or stent failure was 70.9 +/- 10.7% and 60.7 +/- 17.4%, respectively. The majority of late deaths (7/11) were due to cardiac disease.
We conclude that stenting of carotid stenoses is feasible, with a high procedural success rate and low complication rate. Carotid stenting should be considered the procedure of choice for high-risk patients.
颈动脉支架置入术最初是作为一种为特定高危患者替代外科动脉内膜切除术的方法而提出的。最近，具有标准手术风险的患者也在考虑接受经皮颈动脉疾病治疗。
描述在一家机构接受颈动脉支架置入术的首批连续队列患者的临床结果。
在1997年12月至2003年7月期间，111例患者接受了118条颈动脉的支架置入术。收集了围手术期和长期结果数据。
大多数患者（>70%）是动脉内膜切除术的高危候选人。118条颈动脉中有117条成功置入支架（99.2%）。118条中有43条（36.4%）使用了远端保护装置。围手术期死亡或致残性卒中发生率为3/118（2.5%）。11/118（9.3%）发生死亡或任何卒中。然而，只有7/118（5.9%）的手术导致死亡或任何持续性卒中（术后神经功能缺损>1周）。未发生心肌梗死。术后住院时间中位数为1天。101例患者（91.0%）进行了长期随访，平均随访时间为27.1个月。颈动脉支架置入术后36个月和66个月无同侧卒中的Kaplan-Meier生存率估计分别为77.0±9.5%和68.2±15.1%。无任何卒中和支架失败的估计生存率分别为70.9±10.7%和60.7±17.4%。大多数晚期死亡（7/11）归因于心脏病。
我们得出结论，颈动脉狭窄支架置入术是可行的，手术成功率高且并发症发生率低。颈动脉支架置入术应被视为高危患者的首选手术方法。
