Woo Edward Y, Karmacharya Jagajan, Velazquez Omaida C, Carpenter Jeffrey P, Skelly Christopher L, Fairman Ronald M
Division of Vascular Surgery, Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
J Endovasc Ther. 2007 Apr;14(2):208-13. doi: 10.1177/152660280701400213.
To determine the effect of stent coverage of the external carotid artery (ECA) after carotid artery stenting (CAS) compared to eversion endarterectomy of the ECA after carotid endarterectomy (CEA).
The records of 101 CAS and 165 CEA procedures performed over 2 years were reviewed. Duplex velocities and history and physical examinations were taken prior to the procedure, at 1 month, and at 6-month intervals subsequently. CAS was performed by extending the stent across the internal carotid artery (ICA) lesion into the common carotid artery (CCA) thereby covering the ECA. CEA was performed with eversion endarterectomy of the ECA.
The mean peak systolic velocities (PSV) in the ICA pre-CAS and pre-CEA were 361 and 352 cm/s, respectively. In terms of CAS, there was a significant increase in ECA velocities versus baseline at 12 (p = 0.009), 18 (p = 0.00001), and 24 (p = 0.005) months. In the CEA group, there was a significant decrease in ECA velocities versus baseline at 1 (p = 0.01) and 6 (p = 0.004) months. There were 2 occluded ECAs in follow-up in the CAS group and none in the CEA group. No significant differences were noted when comparing preprocedural ICA or ECA velocities. However, at the 1-, 6-, and 12-month intervals, the ECA velocities in the CAS group were significantly higher than in the CEA group (p = 0.03, p = 0.001, and p = 0.0004, respectively). There were no neurological symptoms in any patients during the study period.
Although progressive stenosis of the ECA is noted during CAS, the ECA usually does not occlude. Furthermore, there are no associated neurological symptoms. Thus, apprehension for progressive ECA occlusion should not be a contraindication to CAS. In addition, concern for ECA coverage should not deter stent extension from the ICA to the CCA during CAS.
确定颈动脉支架置入术（CAS）后颈外动脉（ECA）的支架覆盖效果，并与颈动脉内膜切除术（CEA）后ECA外翻内膜切除术的效果进行比较。
回顾了2年内进行的101例CAS和165例CEA手术记录。在手术前、术后1个月以及随后每6个月进行一次双功超声速度测量，并进行病史和体格检查。CAS通过将支架延伸穿过颈内动脉（ICA）病变进入颈总动脉（CCA），从而覆盖ECA来进行。CEA采用ECA外翻内膜切除术。
CAS术前和CEA术前ICA的平均收缩期峰值速度（PSV）分别为361和352cm/s。对于CAS，在术后12个月（p = 0.009）、18个月（p = 0.00001）和24个月（p = 0.005）时，ECA速度相对于基线有显著增加。在CEA组中，术后1个月（p = 0.01）和6个月（p = 0.004）时，ECA速度相对于基线有显著降低。CAS组随访中有2例ECA闭塞，CEA组无。比较术前ICA或ECA速度时未发现显著差异。然而，在术后1个月、6个月和12个月时，CAS组的ECA速度显著高于CEA组（分别为p = 0.03、p = 0.001和p = 0.0004）。研究期间所有患者均无神经症状。
虽然在CAS过程中注意到ECA有进行性狭窄，但ECA通常不会闭塞。此外，没有相关的神经症状。因此，对ECA进行性闭塞的担忧不应成为CAS的禁忌证。此外，在CAS过程中，对ECA覆盖的担忧不应妨碍将支架从ICA延伸至CCA。
