[高危患者的经皮颈动脉支架置入术]

Kerner Arthur, Gruberg Luis, Pitchersky Sirush, Kouperberg Efim, Halabi Majdi, Nikolsky Eugenia, Hoffman Aharon, Beyar Rafael

Division of Invasive Cardiology, Rambam Medical Center and the Technion-Israel Institute of Technology, Haifa, Israel.

Harefuah. 2006 May;145(5):338-41, 399, 398.

UNLABELLED

Recent studies have shown that percutaneous carotid artery angioplasty and stenting can be safely performed in patients with carotid artery stenosis, especially those considered to be at high-risk for surgery.

AIM

We evaluated the safety and feasibility of carotid artery angioplasty and stenting, with and without distal protection devices in patients at high-risk for surgical endarterectomy.

METHODS

A total of 169 consecutive patients underwent 185 procedures and 189 stents were deployed successfully in 195 lesions. The majority of patients (51%) had restenosis after a prior carotid endarterectomy, 40% were considered to be ineligible for carotid endarterectomy by both the vascular surgeons and the interventional cardiologist and 7% were considered ineligible for surgery due to hostile neck anatomy.

RESULTS

Distal embolic protection devices were used in 52% of all cases. Procedural success was achieved in 181 of 185 procedures (98%). The overall rate of in-hospital major adverse cerebrovascular events (death, major stroke, and myocardial infarction) was 2.4%. In-hospital event rates in patients with prior carotid endarterectomy were comparable to patients with de novo lesions with 3.3% vs. 1.1% death/ stroke at 30 days, and 3.3% and 3.3% stroke/death rates at 30 days, respectively. When distal protection devices were used death/stroke rates were 0% as compared to 4.7% when distal protection was not used (p = NS). However, minor embolic phenomena were observed in both primary and secondary lesions independent of the use of distal protection.

CONCLUSIONS

These results support the use of carotid artery angioplasty and stenting in high-risk patients with significant primary or secondary carotid artery stenosis. In both types of lesions, acceptable results justify its use as a valid revascularization method. While clinical embolic events occur in a minority of patients in both lesion types, they are not entirely prevented by distal protection devices.

未标注

近期研究表明，经皮颈动脉血管成形术和支架置入术可安全地应用于颈动脉狭窄患者，尤其是那些被认为手术风险高的患者。

目的

我们评估了在外科内膜切除术高风险患者中，使用和不使用远端保护装置进行颈动脉血管成形术和支架置入术的安全性和可行性。

方法

连续169例患者接受了185次手术，在195处病变中成功置入189枚支架。大多数患者（51%）既往颈动脉内膜切除术后出现再狭窄，40%被血管外科医生和介入心脏病学家认为不适合进行颈动脉内膜切除术，7%因颈部解剖结构复杂被认为不适合手术。

结果

所有病例中52%使用了远端栓塞保护装置。185次手术中有181次（98%）手术成功。院内主要不良脑血管事件（死亡、严重卒中、心肌梗死）总发生率为2.4%。既往有颈动脉内膜切除术患者的院内事件发生率与初发病变患者相当，30天时死亡/卒中发生率分别为3.3%和1.1%，30天时卒中/死亡率分别为3.3%和3.3%。使用远端保护装置时死亡/卒中发生率为0%，未使用远端保护时为4.7%（p=无统计学意义）。然而，无论是否使用远端保护，在原发和继发病变中均观察到轻微栓塞现象。