Kawabata Yasuhiro, Sakai Nobuyuki, Nagata Izumi, Horikawa Fumihiko, Miyake Hidenori, Ueno Yasushi, Kikuchi Haruhiko
Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka, Japan.
J Vasc Interv Radiol. 2009 Jan;20(1):9-16. doi: 10.1016/j.jvir.2008.10.008. Epub 2008 Nov 17.
Carotid artery stent placement has been accepted as an effective alternative to carotid endarterectomy (CEA), especially in patients at high risk in the setting of CEA. The purpose of this study was to determine potential clinical risk factors for the development of postprocedural neurologic deficits after carotid artery stent placement.
The clinical characteristics of 58 patients (49 men, nine women; 41 at high risk with CEA, 17 at low risk; median age, 70 years) who underwent carotid artery stent placement with distal balloon protection for 65 hemispheres/arteries (31 asymptomatic lesions and 34 symptomatic lesions) and the combined 30-day complication rates (transient ischemic attack [TIA], minor stroke, major stroke, or death) were analyzed.
Six patients (9.0%) experienced a TIA and one patient (1.5%) had a major stroke (1.5%) within 30 days of the procedure. There were no deaths, so the overall 30-day combined stroke and death rate was 1.5%. The chi(2) test revealed that advanced age (>75 years) was a significant clinical predictor of 30-day combined neurologic complications and major adverse effects (P < .01). In addition, a symptomatic lesion was marginally associated with the 30-day incidence of neurologic ischemia on the ipsilateral side (P = .049).
Our data suggest that carotid artery stent placement with distal balloon protection can be performed with similar periprocedural complication rates as CEA. CEA should be the first-line treatment in the management of patients older than 75 years of age.
颈动脉支架置入术已被公认为是颈动脉内膜切除术（CEA）的一种有效替代方法，尤其是对于CEA手术风险较高的患者。本研究的目的是确定颈动脉支架置入术后发生术后神经功能缺损的潜在临床危险因素。
分析了58例患者（49例男性，9例女性；41例CEA手术高风险患者，17例低风险患者；中位年龄70岁）的临床特征，这些患者接受了远端球囊保护下的颈动脉支架置入术，共涉及65个半球/动脉（31例无症状病变和34例有症状病变），并分析了30天内的综合并发症发生率（短暂性脑缺血发作[TIA]、轻度卒中、重度卒中和死亡）。
6例患者（9.0%）在术后30天内发生了TIA，1例患者（1.5%）发生了重度卒中（1.5%）。无死亡病例，因此30天内卒中与死亡的综合发生率为1.5%。卡方检验显示，高龄（>75岁）是30天内神经功能综合并发症和主要不良反应的显著临床预测因素（P <.01）。此外，有症状病变与同侧30天内神经缺血发生率存在边缘相关性（P = 0.049）。
我们的数据表明，远端球囊保护下的颈动脉支架置入术与CEA的围手术期并发症发生率相似。对于75岁以上的患者，CEA应作为一线治疗方法。
