Bergeron Patrice, Roux Michel, Khanoyan Patrick, Douillez Valérie, Bras Jacques, Gay Joël
Department of Thoracic and Cardiovascular Surgery, Saint Joseph Hospital, Marseille, France.
J Vasc Surg. 2005 Feb;41(2):213-21; discussion 221-2. doi: 10.1016/j.jvs.2004.11.037.
The feasibility of carotid stenting (CS) is no longer questionable, although its indications remain debatable. Until the results of randomized trials are available, personal series and registries should help in the comparison of long-term results of CS with those of endarterectomy. We report here the long-term results of a large series of CS in our department with a long follow-up. This retrospective study reviews a single surgeon's 11-year experience with CS. Our results are compared with those of conventional surgery emanating from our own series and the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ECST), and Asymptomatic Carotid Atherosclerosis Study (ACAS).
CS has been performed in our department in a single, semi-private institution for 12 years. Patients with high lesions, and postradiotherapy and postendarterectomy stenoses were treated with CS, as were patients at high risk for surgery. The others were operated on with conventional endarterectomy. During the study, we performed 221 CS procedures on 193 patients (150 men and 43 women). The average follow-up was 2.7 years (1 month to 9.3 years). We analyzed the late results in terms of prevention from stroke, the freedom from new neurologic events, and also patency rates of the treated carotid vessels. We also identified predictors for neurologic complication and in-stent restenosis by using univariate analysis.
Life-table analyses at 10 years gave a 96% (confidence interval [CI] = 3%) rate for stroke freedom, a 98% (CI = 2%) rate for fatal stroke freedom, and a primary assisted patency rate of 95% (CI = 3%). Predictors for neurologic complication were [corrected] age >70 ( P = .041), and [corrected] potential renal insufficiency ( P = .056 [corrected] In-stent restenosis occurrence extended from 2 months to 4.5 years after the procedure. The restenosis rates at 6 months, 1, 2, and 4.5 years were, respectively, 1.4%, 2.3%, 3.7%, and 5.9% (13/221). No factors were found to be strong predictors of in-stent restenosis [corrected]
These long-term results show that CS is competitive with conventional surgery. A more accurate selection for CS or surgery might reduce the rate of complications after carotid stenosis repair.
尽管颈动脉支架置入术（CS）的适应证仍存在争议，但其可行性已不再受到质疑。在随机试验结果公布之前，个人系列研究和登记资料应有助于比较CS与内膜切除术的长期结果。我们在此报告本部门一系列大量CS的长期结果，并进行了长期随访。这项回顾性研究回顾了一位外科医生11年的CS经验。我们将结果与来自我们自己系列研究以及北美症状性颈动脉内膜切除术试验（NASCET）、欧洲颈动脉外科试验（ECST）和无症状颈动脉粥样硬化研究（ACAS）的传统手术结果进行了比较。
在我们部门的一个单一的半私立机构中进行CS已达12年。对病变位置高、放疗后和内膜切除术后狭窄的患者以及手术高危患者采用CS治疗，其他患者则接受传统内膜切除术。在研究期间，我们对193例患者（150例男性和43例女性）进行了221次CS手术。平均随访时间为2.7年（1个月至9.3年）。我们从预防中风、无新发神经事件以及治疗的颈动脉通畅率方面分析了晚期结果。我们还通过单因素分析确定了神经并发症和支架内再狭窄的预测因素。
10年的生命表分析显示，无中风发生率为96%（置信区间[CI]=3%），无致命性中风发生率为98%（CI=2%），初次辅助通畅率为95%（CI=3%）。神经并发症的预测因素为年龄>70岁（P=0.041）以及潜在肾功能不全（P=0.056）。支架内再狭窄发生在术后2个月至4.5年。6个月、1年、2年和4.5年的再狭窄率分别为1.4%、2.3%、3.7%和5.9%（13/221）。未发现任何因素是支架内再狭窄的强预测因素。
这些长期结果表明，CS与传统手术具有竞争力。对CS或手术进行更准确的选择可能会降低颈动脉狭窄修复术后的并发症发生率。
