Institute for Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Neuroradiology. 2010 Jul;52(7):611-8. doi: 10.1007/s00234-010-0672-y. Epub 2010 Mar 23.
The discussion on the use of protection devices (PDs) in carotid artery stenting (CAS) is gaining an increasing role in lowering the periprocedural complication rates. While many reviews and reports with retrospective data analysis do promote the use of PDs the most recent multi-centre trials are showing advantages for unprotected CAS combined with closed-cell stent designs.
We retrospectively analysed 358 unprotected CAS procedures performed from January 2003 to June 2009 in our clinic. Male/female ratio was 2.68/1. The average age was 69.3 years. Seventy-three percent (261/358) showed initial neurological symptoms. All patients were treated on a standardised interventional protocol. A closed and small-sized cell designed stent was implanted in most cases (85.2%). One hundred seventy-one (47.8%) were controlled by Doppler ultrasonography usually at first in a 3-month and later in 6-month intervals.
The peri-interventional and 30-day mortality/stroke rate was 4.19% (15/358). These events included three deaths, five hyperperfusion syndromes (comprising one death by a secondary fatal intracranial haemorrhage), one subarachnoid haemorrhage and seven ischaemic strokes. Only 20% (3/15) of all complications occurred directly peri-interventional. The overall peri-interventional complication rate was 0.8% (3/358). Most complications occurred in initial symptomatic patients (5.36%). The in-stent restenosis rate for more than 70% was 7% (12/171) detected at an average of 9.8 month.
Our clinical outcome demonstrates that unprotected CAS with small cell designed stents results in a very low procedural complication rate, which makes the use of a protection device dispensable.
在降低颈动脉支架置入术（CAS）围手术期并发症发生率方面，关于使用保护装置（PDs）的讨论正发挥着越来越重要的作用。虽然许多回顾性数据分析的综述和报告确实提倡使用 PDs，但最近的多中心试验表明，对于未保护的 CAS 联合使用闭孔支架设计具有优势。
我们回顾性分析了 2003 年 1 月至 2009 年 6 月在我们诊所进行的 358 例未经保护的 CAS 手术。男女比例为 2.68/1。平均年龄为 69.3 岁。73%（261/358）有初始神经症状。所有患者均按标准介入治疗方案进行治疗。大多数情况下（85.2%）植入了封闭的、小细胞设计的支架。171 例（47.8%）经多普勒超声检查控制，通常在第一个 3 个月，然后每 6 个月进行一次。
围手术期和 30 天死亡率/中风率为 4.19%（15/358）。这些事件包括三例死亡、五例过度灌注综合征（包括一例继发致命性颅内出血）、一例蛛网膜下腔出血和七例缺血性中风。所有并发症中仅有 20%（3/15）直接发生在围手术期。总的围手术期并发症发生率为 0.8%（3/358）。大多数并发症发生在初始有症状的患者中（5.36%）。在平均 9.8 个月时，发现支架内再狭窄率超过 70%的有 7%（12/171）。
我们的临床结果表明，使用小细胞设计支架进行未保护的 CAS 可导致非常低的手术并发症发生率，这使得使用保护装置变得可有可无。
