Lin Stephanie C, Trocciola Susan M, Rhee Jason, Dayal Rajeev, Chaer Rabih, Morrissey Nicholas J, Mureebe Leila, McKinsey James F, Kent K Craig, Faries Peter L
Department of Vascular Surgery, New York Presbyterian Hospital, Cornell University, Weill Medical School, Columbia University, College of Physicians and Surgeons, New York, NY 10021, USA.
Ann Vasc Surg. 2005 Nov;19(6):798-804. doi: 10.1007/s10016-005-8045-4.
Recent data suggest that patient age >80 years may be associated with increased risk of periprocedural complications from carotid angioplasty and stenting (CAS). In this study, we analyzed anatomic risk factors in patients undergoing CAS based on age >80 or <80 years. Our hypothesis was that patients >80 would have more challenging anatomy. Between February 2003 and August 2004, 82 patients underwent CAS. Images for 57 lesions were available for review. Eighteen patients were > or =80 years old and 39 were <80. Cerebral protection devices, including EPI Filterwire, Percusurge, Accunet, and Angioguard, were used in all but two cases; and self-expanding stents (Wallstent, NexStent, Acculink, Precise) were placed in all. Arterial anatomic characteristics were assigned a score based on complexity and associated procedural risk. Characteristics evaluated using angiographic images were aortic arch elongation classification, arch calcification, common carotid/innominate stenosis, common carotid tortuosity, internal carotid tortuosity, index lesion length, index lesion calcification, and index lesion stenosis. Statistical analysis was performed using Fisher's exact test. CAS was successfully completed in 98% of cases. The two patients in whom we could not perform CAS were 79 and 83 years old. The anatomic characteristics that were statistically significantly more complex/severe in patients > or =80 were arch calcification (p = 0.045), common carotid/innominate stenosis (p = 0.023), common carotid tortuosity (p = 0.049), and internal carotid tortuosity (p = 0.032). There was no statistically significant difference in arch elongation classification, lesion length, lesion calcification, or stenosis severity (p = nonsignificant). Overall, patients > or =80 years had an increased incidence of complex anatomic risk factors compared to younger patients (p < 0.001). Cerebrovascular accident without residual deficits occurred in two patients; both were >80 years old. Complex arterial anatomy is more often present in patients >80 years and may explain the increased complication rates associated with CAS. Pre- or intraoperative consideration of these characteristics may help provide better risk assessment in candidates for CAS.
近期数据表明，年龄大于80岁的患者可能与颈动脉血管成形术和支架置入术（CAS）围手术期并发症风险增加相关。在本研究中，我们分析了年龄大于80岁或小于80岁的接受CAS患者的解剖学危险因素。我们的假设是，年龄大于80岁的患者解剖结构更具挑战性。在2003年2月至2004年8月期间，82例患者接受了CAS。57个病变的图像可供审查。18例患者年龄大于或等于80岁，39例患者年龄小于80岁。除两例外，所有病例均使用了脑保护装置，包括EPI Filterwire、Percusurge、Accunet和Angioguard；所有病例均置入了自膨式支架（Wallstent、NexStent、Acculink、Precise）。根据复杂性和相关手术风险对动脉解剖特征进行评分。使用血管造影图像评估的特征包括主动脉弓延长分类、弓部钙化、颈总动脉/无名动脉狭窄、颈总动脉迂曲、颈内动脉迂曲、靶病变长度、靶病变钙化和靶病变狭窄。采用Fisher精确检验进行统计分析。98%的病例成功完成了CAS。我们未能进行CAS的两名患者年龄分别为79岁和83岁。在年龄大于或等于80岁的患者中，在统计学上显著更复杂/严重的解剖特征是弓部钙化（p = 0.045）、颈总动脉/无名动脉狭窄（p = 0.023）、颈总动脉迂曲（p = 0.049）和颈内动脉迂曲（p = 0.032）。在主动脉弓延长分类、病变长度、病变钙化或狭窄严重程度方面无统计学显著差异（p = 无显著性）。总体而言，与年轻患者相比，年龄大于或等于80岁的患者复杂解剖学危险因素的发生率更高（p < 0.001）。两名患者发生了无残留神经功能缺损的脑血管意外；两人均年龄大于80岁。复杂的动脉解剖结构在年龄大于80岁的患者中更常见，这可能解释了与CAS相关的并发症发生率增加的原因。术前或术中考虑这些特征可能有助于为CAS候选者提供更好的风险评估。
