Perona Franco, Castellazzi Giorgio, Valvassori Luca, Boccardi Edoardo, de Girolamo Laura, Cornalba Gian Paolo, Kandarpa Krishna
Department of Radiology, IRCCS Galeazzi Orthopaedic Institute, Via Riccardo Galeazzi 4, 20161 Milan, Italy.
Radiology. 2009 Jan;250(1):178-83. doi: 10.1148/radiol.2493080057. Epub 2008 Nov 18.
To retrospectively evaluate the outcome of carotid artery stent placement (CAS) without the use of embolic protection devices (EPDs) in a large cohort of patients.
Institutional review board approval and informed consent from all patients were obtained. Preprocedure color Doppler ultrasonography (US), magnetic resonance (MR) imaging, or computed tomography (CT) were used to evaluate stenosis severity (70% or greater). Clinical findings and combined 30-day complication rates in 400 patients (289 men, 111 women; mean age, 73 years +/- 8 [standard deviation]) who underwent unprotected CAS for asymptomatic (n = 156; 39%) or symptomatic (n = 244, 61%) stenoses were analyzed. Follow-up at 30 days included neurologic evaluation and color Doppler US.
Self-expanding stents were successfully deployed in 397 of 400 (99.25%) patients. Among the 397 patients, nine (2.27%) major complications (all in patients with prior symptoms) had occurred at 30 days, including three (0.76%) major (all in patients who had stopped antiplatelet prophylaxis) and six (1.5%) minor strokes--three intraprocedural and three delayed. Minor complications included 16 (4%) transient ischemic attacks, four in asymptomatic and 12 in symptomatic patients. The 30-day combined adverse outcomes (transient ischemic attack, ipsilateral stroke, death) were significantly correlated with prior presence of symptoms (symptomatic, 8.6%; asymptomatic, 2.6%; P < .03).
Stent placement without EPD was performed with a high technical success rate. For asymptomatic patients, the combined 30-day adverse-outcomes rate was within the limits recommended by the American Heart Association for carotid endarterectomy and compared favorably with results reported for CAS with EPD. When a transient ischemic attack is excluded, the 30-day combined death and stroke rate among patients with prior symptoms also compared favorably with published results.
回顾性评估在一大群患者中不使用栓子保护装置（EPD）进行颈动脉支架置入术（CAS）的结果。
获得机构审查委员会批准并征得所有患者的知情同意。术前使用彩色多普勒超声（US）、磁共振（MR）成像或计算机断层扫描（CT）评估狭窄严重程度（70%或更高）。分析了400例患者（289例男性，111例女性；平均年龄73岁±8[标准差]）因无症状（n = 156；39%）或有症状（n = 244，61%）狭窄接受非保护CAS的临床发现和30天综合并发症发生率。30天随访包括神经学评估和彩色多普勒超声。
400例患者中有397例（99.25%）成功植入自膨式支架。在这397例患者中，9例（2.27%）在30天时发生了主要并发症（均为有既往症状的患者），包括3例（0.76%）严重并发症（均为停止抗血小板预防的患者）和6例（1.5%）轻度中风——3例术中中风和3例延迟性中风。轻度并发症包括16例（4%）短暂性脑缺血发作，无症状患者4例，有症状患者12例。30天综合不良结局（短暂性脑缺血发作、同侧中风、死亡）与既往是否有症状显著相关（有症状者为8.6%；无症状者为2.6%；P < 0.03）。
不使用EPD进行支架置入术技术成功率高。对于无症状患者，30天综合不良结局率在美国心脏协会推荐的颈动脉内膜切除术范围内，且与使用EPD的CAS报告结果相比具有优势。排除短暂性脑缺血发作后，既往有症状患者的30天综合死亡和中风率与已发表结果相比也具有优势。
