Zahn Ralf, Ischinger Thomas, Hochadel Matthias, Mark Bernd, Zeymer Uwe, Schmalz Wolfgang, Schramm Alexander, Hauptmann Karl Eugen, Seggewiss Hubert, Janicke Ilse, Mudra Harald, Senges Jochen
Herzzentrum Ludwigshafen, Kardiologie, Ludwigshafen, Germany.
Catheter Cardiovasc Interv. 2009 Jul 1;74(1):1-8. doi: 10.1002/ccd.22050.
To determine the influence of the side intervened upon on outcomes during carotid artery stenting (CAS).
Anatomic and technical aspects may influence the results of CAS. The value of the side intervened upon has not been analyzed yet.
We analyzed data from the Carotid Artery Stent (CAS)-Registry.
A total of 3,165 CAS procedures, 1,613 (51%) at the left and 1,552 (49%) at the right carotid artery were included. There was a higher proportion of patients treated for symptomatic stenoses when CAS was performed at the left carotid artery (50.1% versus 45.8%, P = 0.016) and more patients already had prior carotid endarterectomy (8.5% versus 5.8%, P = 0.003). Interventions at the left side took 3 min longer than interventions at the right side (46.6 +/- 24.3 versus 43.8 +/- 23.6, P = 0.003). In patients treated at the left carotid artery amaurosis fugax (0.7% versus 0.1%, P = 0.005), ipsilateral stroke (3.1% versus 1.8%, P = 0.017), and the primary endpoint of in-hospital death or stroke (4.1% versus 2.3%, P = 0.005) occurred significantly more often. Even after adjusting for confounding parameters, CAS procedures performed at the left carotid arteries remained an independent predictor of death or stroke (OR = 1.77, 95% CI: 1.15-2.72, P = 0.009).
In current clinical practice, CAS is performed frequently at the right carotid artery as at the left carotid artery. CAS interventions have a higher in-hospital complication rate if performed at the left carotid artery. Technical improvements might help to overcome this situation.
确定颈动脉支架置入术（CAS）过程中干预侧对手术结果的影响。
解剖学和技术因素可能会影响CAS的结果。然而，干预侧的价值尚未得到分析。
我们分析了来自颈动脉支架置入术（CAS）注册中心的数据。
共纳入3165例CAS手术，其中1613例（51%）在左颈动脉进行，1552例（49%）在右颈动脉进行。在左颈动脉进行CAS时，因症状性狭窄接受治疗的患者比例更高（50.1%对45.8%，P = 0.016），并且已有更多患者接受过颈动脉内膜切除术（8.5%对5.8%，P = 0.003）。左侧的干预操作比右侧长3分钟（46.6±24.3对43.8±23.6，P = 0.003）。在左颈动脉接受治疗的患者中，一过性黑矇（0.7%对0.1%，P = 0.005）、同侧卒中（3.1%对1.8%，P = 0.017）以及院内死亡或卒中的主要终点事件（4.1%对2.3%，P = 0.005）的发生率明显更高。即使在对混杂参数进行校正后，在左颈动脉进行的CAS手术仍然是死亡或卒中的独立预测因素（OR = 1.77，95% CI：1.15 - 2.72，P = 0.009）。
在当前临床实践中，CAS在右颈动脉和左颈动脉的实施频率相近。在左颈动脉进行CAS干预时，院内并发症发生率更高。技术改进可能有助于克服这种情况。
