Cohen José E, Umansky Felix, Rajz Gustavo, Ben-Hur Tamir
Department of Neurosurgery, Hadassah-Hebrew University Hospital, Jerusalem, Israel.
Neurol Res. 2005;27 Suppl 1:S59-63. doi: 10.1179/016164105X49584.
The North American Symptomatic Carotid Endarterectomy Trial (NASCET) excluded patients with severe medical, angiographic and neurological risk factors. The aim of this study is to determine the safety and efficacy of protected stent angioplasty in these high-risk patients.
Sixty-eight consecutive symptomatic NASCET-ineligible patients underwent protected stent-assisted carotid angioplasty. Patients were classified according to surgical risk based on Sundt criteria, and stratified for medical therapy according to stroke risk. Twenty-one patients were classified as Sundt grade 3 (30.8%) and 36 patients as grade 4 (52.9%).
The procedure was technically successful in all patients, with stenosis averaging 82.1% (range 70-99%) before the procedure and 6.3% (range 0-30%) after treatment. There were no periprocedural deaths or major strokes, but two patients had minor, non-embolic stokes (2.9%). During a mean clinical follow-up of 14.4 months (range 1-30 months), no new neurological events occurred in relation to the treated vascular territory.
Carotid angioplasty with cerebral protection can be performed safely in high-risk patients. During the follow-up period, angioplasty was highly effective in terms of stroke prevention and arterial patency.
北美症状性颈动脉内膜切除术试验（NASCET）排除了患有严重内科、血管造影和神经危险因素的患者。本研究的目的是确定在这些高危患者中进行带保护装置的支架血管成形术的安全性和有效性。
连续68例不符合NASCET标准的有症状患者接受了带保护装置的支架辅助颈动脉血管成形术。根据Sundt标准对患者进行手术风险分类，并根据中风风险对内科治疗进行分层。21例患者被分类为Sundt 3级（30.8%），36例患者为4级（52.9%）。
该手术在所有患者中技术上均获成功，术前平均狭窄率为82.1%（范围70 - 99%），治疗后为6.3%（范围0 - 30%）。围手术期无死亡或重大中风发生，但有2例患者发生轻微的非栓塞性中风（2.9%）。在平均14.4个月（范围1 - 30个月）的临床随访期间，与治疗的血管区域相关未发生新的神经事件。
在高危患者中可安全地进行带脑保护的颈动脉血管成形术。在随访期间，血管成形术在预防中风和动脉通畅方面非常有效。
