颈动脉支架置入术后颈外动脉的转归：一项双功超声随访研究

The fate of the external carotid artery after carotid artery stenting. A follow-up study with duplex ultrasonography.

作者信息

de Borst G J, Vos J A, Reichmann B, Hellings W E, de Vries J P P M, Suttorp M J, Moll F L, Ackerstaff R G A

机构信息

Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.

出版信息

Eur J Vasc Endovasc Surg. 2007 Jun;33(6):657-63. doi: 10.1016/j.ejvs.2007.01.010. Epub 2007 Mar 2.

DOI:10.1016/j.ejvs.2007.01.010

PMID:17337347

Abstract

OBJECTIVE

To evaluate the long-term effect of carotid angioplasty and stenting (CAS) of the internal carotid artery (ICA) on the ipsilateral external carotid artery (ECA).

SUBJECTS AND METHODS

We prospectively registered the pre- and post-interventional duplex scans obtained from 312 patients (mean age 70 years) who underwent CAS. Duplex scans were scheduled the day before CAS, 3 and 12 months post-procedurally and yearly thereafter, to study progression of obstructive disease in the ipsilateral ECA compared to the contralateral ECA. The duplex ultrasound criteria used to identify ECA stenosis >or=50% were Peak Systolic Velocities of >or=125 cm/s.

RESULTS

Preprocedural evaluation of the ipsilateral ECA demonstrated >or=50% stenosis in 32.7% of cases vs 30% contralateral. Both ipsilateral and contralateral 3 (1%) ECA occlusions were noted. After stenting 5 (1.8%) occlusions were seen vs 1% contralateral. No additional ipsilateral occlusions and 2 additional contralateral occlusions were noted at extended follow-up. The prevalence of >or=50% stenosis of the ipsilateral ECA (Kaplan-Meier estimates) progressed from 49.1% at 3, to 56.4%, 64.7%, 78.2%, 72.3%, and 74% at 12, 24, 36, 48, and 60 months respectively. Contralateral prevalences were 31.3%, 37.7%, 41.7%, 43.1%, 46.0%, and 47.2% respectively (p<0.001). Progression of stenosis was more pronounced in 234 patients (75%) with overstenting of the carotid bifurcation (p=0.004).

CONCLUSION

Our results show that significant progression of >or=50% stenosis in the ipsilateral ECA occurs after CAS. There was greater progression of disease in the ipsilateral compared with the contralateral ECA. Progression of disease in the ECA did not lead to the occurrence of occlusion during follow up.

摘要

目的

评估颈内动脉（ICA）血管成形术和支架置入术（CAS）对同侧颈外动脉（ECA）的长期影响。

对象与方法

我们前瞻性地记录了312例接受CAS患者（平均年龄70岁）介入治疗前后的双功超声扫描结果。双功超声扫描安排在CAS术前、术后3个月和12个月以及此后每年进行，以研究同侧ECA与对侧ECA相比阻塞性疾病的进展情况。用于识别ECA狭窄≥50%的双功超声标准为收缩期峰值流速≥125 cm/s。

结果

同侧ECA的术前评估显示，32.7%的病例存在≥50%的狭窄，对侧为30%。同侧和对侧均有3例（1%）ECA闭塞。支架置入术后，同侧出现5例（1.8%）闭塞，对侧为1%。延长随访期间，未发现额外的同侧闭塞，对侧出现2例额外闭塞。同侧ECA狭窄≥50%的患病率（Kaplan-Meier估计值）从3个月时的49.1%分别进展至12、24、36、48和60个月时的56.4%、64.7%、78.2%、72.3%和74%。对侧患病率分别为31.3%、37.7%、41.7%、43.1%、46.0%和47.2%（p<0.001）。在234例（75%）颈动脉分叉处过度支架置入的患者中，狭窄进展更为明显（p=0.004）。