Cohen José E, Rajz Gustavo, Lylyk Pedro, Ben-Hur Tamir, Gomori John M, Umansky Felix
Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel.
Neurol Res. 2005;27 Suppl 1:S69-72. doi: 10.1179/016164105X25333.
The surgical treatment of radiation-induced carotid stenosis is challenging and presents a high rate of complications. This has led several investigators to propose stent-assisted angioplasty as the treatment of choice for this condition. The aim of this study is to evaluate the potential risks of intra-procedural embolic stroke in this setting using cerebral protection devices.
We describe our recent experience in the endovascular treatment by means of stent-assisted angioplasty with the aid of a filter cerebral protection device of eight patients presenting with radiation-induced carotid stenosis.
Procedural success, defined as residual stenosis of less than 30% was obtained in all cases. The mean percentage stenosis was reduced from mean 80+/-6.3% (range 70-90%) to 13+/-4% (range 10-20%). Predilation was performed in five cases, post-dilation in all the cases. Mild-to-moderate bradycardia while inflating the balloon was present in three cases and was severe in one case. No patient sustained myocardial infarction, stroke or TIA during the procedure or hospital stay. During a mean clinical follow-up of 16+/-7.3 months (range 5-25) there were no neurological events. On sonographic follow-up, no patient presented in-stent de novo stenosis.
Carotid angioplasty with cerebral protection can be performed safely in radiation-induced carotid stenosis with a high technical success rate. With the recent innovations and improvements in angioplasty technique, its indications and results will have to be redefined. Given the complexity and complications of surgical approaches for this condition, and the encouraging results obtained with endovascular techniques, carotid angioplasty emerges as the preferred treatment option.
放射性颈动脉狭窄的外科治疗具有挑战性且并发症发生率高。这使得一些研究者提出支架辅助血管成形术作为这种疾病的首选治疗方法。本研究的目的是使用脑保护装置评估在这种情况下术中栓塞性中风的潜在风险。
我们描述了近期对8例放射性颈动脉狭窄患者借助滤器脑保护装置通过支架辅助血管成形术进行血管内治疗的经验。
所有病例均获得手术成功，定义为残余狭窄小于30%。平均狭窄百分比从平均80±6.3%（范围70 - 90%）降至13±4%（范围10 - 20%）。5例患者进行了预扩张，所有病例均进行了后扩张。3例患者在球囊扩张时出现轻度至中度心动过缓，1例严重。术中及住院期间无患者发生心肌梗死、中风或短暂性脑缺血发作。在平均16±7.3个月（范围5 - 25个月）的临床随访期间，无神经事件发生。超声随访中，无患者出现支架内新生狭窄。
在放射性颈动脉狭窄中，采用脑保护的颈动脉血管成形术可安全进行，技术成功率高。随着血管成形术技术的最新创新和改进，其适应证和结果将不得不重新定义。鉴于这种疾病外科手术方法的复杂性和并发症，以及血管内技术取得的令人鼓舞的结果，颈动脉血管成形术成为首选治疗方案。
