Cohen José E, Gomori John M, Rajz Gustavo, Ben-Hur Tamir, Umansky Felix
Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel.
Neurol Res. 2005;27 Suppl 1:S64-8. doi: 10.1179/016164105X35422.
The high complication rate associated with the surgical treatment of post-carotid endarterectomy restenosis has led several investigators to propose stent-assisted angioplasty as the treatment of choice for this condition. Late restenosis is very infrequent and mainly due to atherosclerotic progression. The aim of this study is to evaluate the potential risk of intraprocedural embolic stroke during stent-assisted angioplasty with cerebral protection devices in these patients.
We describe our recent experience in the endovascular treatment of 10 patients presenting late carotid restenosis by means of stent-assisted angioplasty with the aid of a filter cerebral protection device. Mean elapsed time from surgery to angioplasty was 92+/-31 months (range 48-144 months).
Procedural success was obtained in all the cases. Pre-dilation was performed in six cases, post-dilation in all the cases. The mean percentage stenosis was reduced from mean 77+/-12% (range 60-95%) to 6.3+/-6.7% (range 0-17%). Bradycardia while inflating the balloon was mild-to-moderate in seven cases and severe in two. No patient sustained stroke or transient ischemic attack (TIA) during the procedure or during hospital stay. On follow-up, two patients presented with moderate asymptomatic restenosis and were managed conservatively.
Carotid angioplasty with cerebral protection can be performed safely in late carotid restenosis with a high technical success rate. No clinical embolic complications occurred in this subset of patients. With recent innovations and improvements in angioplasty technique, previous indications for angioplasty in these patients will have to be redefined. Carotid angioplasty seems to be a valuable treatment alternative to conventional surgery in this subset of patients.
颈动脉内膜切除术后再狭窄的外科治疗并发症发生率较高，这使得一些研究人员提出支架辅助血管成形术作为这种情况的首选治疗方法。晚期再狭窄非常罕见，主要是由于动脉粥样硬化进展所致。本研究的目的是评估在这些患者中使用脑保护装置进行支架辅助血管成形术期间发生术中栓塞性中风的潜在风险。
我们描述了最近对10例出现晚期颈动脉再狭窄的患者进行血管内治疗的经验，采用支架辅助血管成形术并借助滤器脑保护装置。从手术到血管成形术的平均时间为92±31个月（范围48 - 144个月）。
所有病例均获得手术成功。6例进行了预扩张，所有病例均进行了后扩张。平均狭窄百分比从平均77±12%（范围60 - 95%）降至6.3±6.7%（范围0 - 17%）。7例患者在球囊充气时出现轻度至中度心动过缓，2例为重度。在手术过程中或住院期间，没有患者发生中风或短暂性脑缺血发作（TIA）。随访时，2例患者出现中度无症状再狭窄，经保守治疗。
在晚期颈动脉再狭窄患者中，采用脑保护的颈动脉血管成形术可以安全地进行，技术成功率高。在这组患者中未发生临床栓塞并发症。随着血管成形术技术的最新创新和改进，这些患者以前的血管成形术适应证将不得不重新定义。在这组患者中，颈动脉血管成形术似乎是传统手术的一种有价值的替代治疗方法。
