Kadkhodayan Yasha, Cross Dewitte T, Derdeyn Colin P, Moran Christopher J
Interventional Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd, St. Louis, MO, 63110, USA.
Neuroradiology. 2007 Nov;49(11):933-8. doi: 10.1007/s00234-007-0278-1. Epub 2007 Jul 27.
To investigate the technical success rate as well as the procedural and mid-term complication rates of carotid angioplasty and stenting in elderly patients, a group excluded from large randomized endarterectomy trials given their perceived high surgical risk.
Of 200 consecutive carotid angioplasty and/or stenting procedures performed between March 1996 and March 2005, 21 procedures were performed without cerebral protection devices in 20 patients over the age of 79 years (mean age: 83 years, 12 men, eight women). These patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and mid-term complication rates were calculated and compared to a previously published cohort of 133 consecutive patients < or = 79 years of age who also underwent endovascular treatment at our institution.
Carotid stenosis was reduced from a mean of 82% to no significant stenosis in all procedures. The procedural stroke rate was zero of 21 procedures. The procedural transient ischemic attack rate (TIA) was one of 21 procedures (4.8%). Mean follow-up was 24.6 months (range: 1.0-79.5 months) with at least a 30-day follow-up for 20 of the 21 procedures (95.2%). There were no new strokes. There was one recurrent ipsilateral TIA at 1.9 months. In five cases with follow-up carotid ultrasonography, no hemodynamically significant restenosis had occurred. There were three myocardial infarctions (MI) occurring at 0.5, 2.1, and 15.2 months, of which the last MI was fatal. The composite 30-day stroke and death rate was zero of 21 procedures (95% confidence interval: 0-14%). No significant difference was found in the 30-day rate of stroke, TIA, MI, or death between the elderly and younger patients.
Carotid angioplasty and stenting in elderly patients can be performed successfully with acceptable procedural and mid-term complication rates comparable to younger patients.
为了研究老年患者颈动脉血管成形术和支架置入术的技术成功率以及手术中和中期并发症发生率，该老年患者群体因被认为手术风险高而被排除在大型随机内膜切除术试验之外。
在1996年3月至2005年3月期间连续进行的200例颈动脉血管成形术和/或支架置入术中，20例79岁以上患者（平均年龄：83岁，12名男性，8名女性）的21例手术未使用脑保护装置。对这些患者的病历进行回顾性审查，以获取血管成像报告和可用的临床随访资料。计算手术中和中期并发症发生率，并与本院之前发表的133例年龄≤79岁且也接受血管内治疗的连续患者队列进行比较。
所有手术中，颈动脉狭窄率从平均82%降至无明显狭窄。21例手术的手术期卒中率为零。21例手术中有1例发生手术期短暂性脑缺血发作（TIA）（4.8%）。平均随访时间为24.6个月（范围：1.0 - 79.5个月），21例手术中有20例至少随访了30天（95.2%）。无新发卒中。1.9个月时出现1例同侧复发性TIA。5例接受随访颈动脉超声检查的患者未发生血流动力学上有意义的再狭窄。在0.5、2.1和15.2个月时发生了3例心肌梗死（MI），其中最后1例MI是致命的。21例手术的30天卒中与死亡率综合为零（95%置信区间：0 - 14%）。老年患者与年轻患者在30天卒中、TIA、MI或死亡率方面未发现显著差异。
老年患者的颈动脉血管成形术和支架置入术可以成功进行，其手术中和中期并发症发生率与年轻患者相当，是可以接受的。
