Maynar M, Baldi S, Rostagno R, Zander T, Rabellino M, Llorens R, Alvarez J, Barajas F
Department of Endovascular Therapy, Hospiten Rambla Hospital, Tenerife, Spain.
AJNR Am J Neuroradiol. 2007 Aug;28(7):1378-83. doi: 10.3174/ajnr.A0543.
A major concern during carotid artery stent placement is the potential for cerebral embolism. Diminishing the number of device manipulations across the lesion might reduce procedural stroke risk. For this purpose, we report our initial experience with carotid stent placement without the use of either balloon angioplasty or distal protection devices.
Eighty-seven consecutive patients with 100 carotid stenoses compose this series. Ninety four of the 100 hundred stented carotid arteries were either symptomatic (58 [58%]) or had a greater than 70% stenosis (36 [36%]). Six percent of them were asymptomatic and had stenosis between 50% and 70%. Patients underwent neurologic evaluation before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Carotid sonography and plain films of the neck were performed immediately after the procedure and then at the same time intervals.
Primary stent placement was successful in 98 of 100 case subjects. In 2 case subjects, predilation was necessary before stent deployment. Neurologic periprocedural complications included 1 nondisabling and 1 disabling stroke and 5 transient ischemic attacks. The mean duration of follow-up was 23 months (range: 10-36 months). During the follow-up period, there were 5 deaths, all unrelated to the carotid disease, and no major stroke. The degree of stenosis decreased from a mean of 78.85% before the procedure to a mean of 21.23% immediately after.
In this series, carotid stent placement without the use of either balloon angioplasty or distal protection devices was safe and effective with a low incidence of periprocedural complications.
颈动脉支架置入过程中的一个主要担忧是发生脑栓塞的可能性。减少器械在病变部位的操作次数可能会降低手术中风风险。为此，我们报告了在不使用球囊血管成形术或远端保护装置的情况下进行颈动脉支架置入的初步经验。
本系列包括连续87例患有100处颈动脉狭窄的患者。100条接受支架置入的颈动脉中，94条要么有症状（58条[58%]），要么狭窄程度大于70%（36条[36%]）。其中6%无症状，狭窄程度在50%至70%之间。患者在手术前以及术后1、3、6和12个月及之后每年进行神经学评估。术后立即以及随后在相同时间间隔进行颈动脉超声检查和颈部平片检查。
100例受试者中有98例首次支架置入成功。2例受试者在支架置入前需要进行预扩张。围手术期神经学并发症包括1例非致残性中风、1例致残性中风和5例短暂性脑缺血发作。平均随访时间为23个月（范围：10 - 36个月）。随访期间有5例死亡，均与颈动脉疾病无关，且无重大中风发生。狭窄程度从术前平均78.85%降至术后立即平均21.23%。
在本系列中，不使用球囊血管成形术或远端保护装置进行颈动脉支架置入是安全有效的，围手术期并发症发生率低。
