Arici Melih, Dahn Judith E, Desai Nihar, Dahn Michael S
University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3955, USA.
Conn Med. 2005 Sep;69(8):453-6.
Carotid endarterectomy (CEA) has become established as the preferred approach to the management of critical carotid stenosis. Carotid angioplasty with stenting (CAS) has recently arisen as an alternative in the treatment of carotid occlusive disease. This report describes our experience with carotid angioplasty applied to an unselected patient population suffering from high-grade carotid occlusive disease.
All patients suffering from carotid stenosis (> 50% symptomatic or > 80% asymptomatic) were offered CAS or CEA. The first 39 patients who underwent attempted CAS over this last year are reported here. CAS was performed with the SMART PRECISE or ACCULINK stents. All procedures were performed with cerebral protection.
The planned procedure success rate was 97% and the major adverse event (MAE) rate was 2.6% in 38 patients who underwent successful CAS. This included a minor stroke and a subendocardial myocardial infarction in the same individual. Both events were attributed to sustained postprocedural hypotension probably induced by increased carotid sinus activity.
CAS can be accomplished with a MAE rate comparable to CEA and will likely become the dominant alternative to CEA for the management of carotid stenosis. In the setting of equivalent morbidity, it appears likely that a nonsurgical option will be preferred by patients.
颈动脉内膜切除术（CEA）已成为治疗严重颈动脉狭窄的首选方法。颈动脉血管成形术加支架置入术（CAS）最近已成为治疗颈动脉闭塞性疾病的一种替代方法。本报告描述了我们对应用于未经选择的患有重度颈动脉闭塞性疾病患者群体的颈动脉血管成形术的经验。
所有患有颈动脉狭窄（症状性狭窄>50%或无症状性狭窄>80%）的患者都可选择CAS或CEA。本文报告了去年接受CAS尝试的前39例患者。CAS使用SMART PRECISE或ACCULINK支架进行。所有手术均采用脑保护措施。
在38例成功接受CAS的患者中，计划手术成功率为97%，主要不良事件（MAE）发生率为2.6%。这包括同一患者发生的一次轻度中风和一次心内膜下心肌梗死。这两个事件均归因于术后持续低血压，可能是由颈动脉窦活动增加引起的。
CAS可以实现与CEA相当的MAE发生率，并且可能会成为治疗颈动脉狭窄的CEA的主要替代方法。在发病率相当的情况下，患者似乎更倾向于非手术选择。
