Department of Vascular Surgery, Sant'Andrea Hospital, La Sapienza University of Rome (Second Medical School), Via di Grottarossa 1035, 00189 Rome, Italy.
Eur J Vasc Endovasc Surg. 2010 Mar;39(3):252-7. doi: 10.1016/j.ejvs.2009.11.011. Epub 2009 Nov 27.
Filter-protected transcervical carotid artery stenting (CAS) has been suggested to reduce the intraoperative cerebral embolisation observed during transfemoral CAS. We therefore evaluated clinical outcome and incidence of ischaemic lesions at diffusion-weighted magnetic resonance imaging (DW-MRI) after transcervical and transfemoral CAS.
From March 2007 to May 2009, we performed filter-protected CAS in 135 patients with symptomatic (30%) or asymptomatic (70%) carotid stenosis above 70% and below 95%. In 44 patients with risky femoral access or unfavourable aortic arch anatomy, access to common carotid artery was achieved by a small cervical incision. In another 91 procedures we used a classic percutaneous femoral access. Preoperative and postoperative DW-MRI scans were obtained after 111 procedures (82%) - 35 transcervical and 76 transfemoral.
The incidence of clinical events (transient ischaemic attack (TIA) and stroke) was 2.3% after transcervical CAS and 19.8% after transfemoral CAS (P<0.01), without any deaths. DW-MRI disclosed new ischaemic lesions in five patients (5/35, 14.3%) after transcervical CAS and in 28 patients (28/76, 36.8%) after transfemoral CAS (P=0.015). All ischaemic lesions depicted after transcervical procedures were ipsilateral to the treated artery.
Transcervical filter-protected CAS, compared with classic percutaneous procedures, seems to reduce clinical events and DW-MRI ischaemic damage and may be useful in selected patients.
滤器保护经颈内动脉颈动脉支架置入术（CAS）已被证明可减少经股动脉 CAS 术中观察到的术中脑栓塞。因此，我们评估了经颈内和经股动脉 CAS 后的临床结果和弥散加权磁共振成像（DW-MRI）上缺血性病变的发生率。
从 2007 年 3 月到 2009 年 5 月，我们对 135 例症状性（30%）或无症状性（70%）颈动脉狭窄超过 70%但低于 95%的患者进行了滤器保护 CAS。在 44 例股动脉入路风险大或主动脉弓解剖结构不佳的患者中，通过小的颈部切口进入颈总动脉。在另外 91 例手术中，我们使用了经典的经皮股动脉入路。在 111 例（82%）手术中获得了术前和术后 DW-MRI 扫描-35 例经颈内和 76 例经股。
经颈内 CAS 后临床事件（短暂性脑缺血发作（TIA）和中风）的发生率为 2.3%，经股 CAS 后为 19.8%（P<0.01），无死亡。DW-MRI 显示 5 例（5/35，14.3%）经颈内 CAS 后和 28 例（28/76，36.8%）经股 CAS 后出现新的缺血性病变（P=0.015）。经颈内手术后出现的所有缺血性病变均与治疗的动脉同侧。
与经典的经皮手术相比，经颈内滤器保护 CAS 似乎可降低临床事件和 DW-MRI 缺血性损伤的发生率，并且可能对某些患者有用。
