Schillinger Martin, Gschwendtner Manfred, Reimers Bernhard, Trenkler Johannes, Stockx Luc, Mair Johann, Macdonald Sumaira, Karnel Franz, Huber Kurt, Minar Erich
Department of Angiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Stroke. 2008 Mar;39(3):905-9. doi: 10.1161/STROKEAHA.107.499145. Epub 2008 Jan 31.
Carotid stent cell design has recently been suggested to be a determinant of periprocedural and early postprocedural neurologic complications. We investigated the impact of closed- versus open-cell stent design on neurologic adverse events and mortality after carotid artery stenting.
We studied 1684 consecutive patients (1010 asymptomatic, 674 symptomatic) from 10 European centers who underwent carotid artery stenting with either closed-cell (n=859, 51%) or open-cell (n=825, 49%) design stents. Rates of transient ischemic attack, stroke, and death on the day of the procedure (acute events) and from day 1 to day 30 after the procedure (subacute events) were analyzed (95% CIs).
Combined transient ischemic attack, stroke, or death rates, and stroke or death rates within 30 days of treatment were 6.1% (95% CI, 5.0 to 7.2) and 3.1% (95% CI, 2.3 to 3.9) for the closed-cell design versus 4.1% (95% CI, 3.2 to 5.0) and 2.4% (95% CI, 1.7 to 3.1) for the open-cell design stents (P=0.077, P=0.38), respectively, without significant differences in asymptomatic and symptomatic patients. By propensity-score-adjusted multivariable analysis, the open-cell carotid stent design was not associated with a differential risk for combined acute and subacute neurologic complications compared with closed-cell stents (adjusted odds ratio=0.84, P=0.53). When analyzed separately, the risk for acute events on the day of the procedure (adjusted odds ratio=0.83, P=0.57) and the risk for subacute events at days 1 to 30 (adjusted odds ratio=1.61, P=0.51) also were not significantly different between the groups.
Current data do not support the superiority of a specific carotid stent cell design with respect to neurologic complications, stroke, and mortality risk.
近期有观点认为颈动脉支架的网孔设计是围手术期及术后早期神经并发症的一个决定因素。我们研究了闭合型与开放型网孔支架设计对颈动脉支架置入术后神经不良事件和死亡率的影响。
我们研究了来自10个欧洲中心的1684例连续患者（1010例无症状，674例有症状），这些患者接受了采用闭合型网孔设计支架（n = 859，51%）或开放型网孔设计支架（n = 825，49%）的颈动脉支架置入术。分析了手术当天（急性事件）以及术后第1天至第30天（亚急性事件）的短暂性脑缺血发作、卒中及死亡发生率（95%可信区间）。
闭合型网孔设计支架组的短暂性脑缺血发作、卒中或死亡合并发生率以及治疗后30天内的卒中或死亡发生率分别为6.1%（95%可信区间，5.0%至7.2%）和3.1%（95%可信区间，2.3%至3.9%），而开放型网孔设计支架组分别为4.1%（95%可信区间，3.2%至5.0%）和2.4%（95%可信区间，1.7%至3.1%）（P = 0.077，P = 0.38），无症状和有症状患者之间无显著差异。通过倾向评分调整的多变量分析，与闭合型网孔支架相比，开放型颈动脉支架设计与急性和亚急性神经并发症的差异风险无关（调整后的优势比 = 0.84，P = 0.53）。单独分析时，两组在手术当天的急性事件风险（调整后的优势比 = 0.83，P = 0.57）以及第1天至第30天的亚急性事件风险（调整后的优势比 = 1.61，P = 0.51）也无显著差异。
目前的数据不支持特定的颈动脉支架网孔设计在神经并发症、卒中和死亡风险方面具有优越性。
