Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Italy.
J Vasc Surg. 2010 Jun;51(6):1397-405. doi: 10.1016/j.jvs.2010.02.009.
This study was conducted to identify the prevalence, risk factors, and clinical relevance of carotid artery stent fracture.
Commercially available carotid stents were implanted in this prospective, observational study that began in January 2004. Indications included asymptomatic patients (stenosis >80%), symptomatic patients (stenosis >60%), and ulcerated lesions (>50%). Stent integrity was assessed with plain radiography at 12 months. Data were analyzed in April 2009 on a series of 341 consecutive patients treated with carotid artery stenting with at least 12 months follow-up.
Stent fracture prevalence was 3.4% at 12 months (95% confidence interval, 1.7%-6.1%). The median clinical follow-up was 30 months (range, 12-64 months) for 323 eligible patients. Treatment included 23.6% of symptomatic patients. According to univariate analysis, calcification type III increased the odds of stent fracture by more than 4.5 times (odds ratio [OR], 4.74; P = .006) and angulation >45 degrees increased the odds of stent fracture by 6.5 times (OR, 6.51; P = .008). Carotid stent cell type, stent length, and stent over-sizing were not correlated with stent fracture incidence. Stent fracture was not associated with stroke (0%), transient ischemic attack (0%), or death (0%). Restenosis was significantly associated with stent fracture (P < .001). Multivariate analysis evidenced that type III calcification (OR, 3.90; P = .029) and angulation >45 degrees (OR, 4.69; P = .026) were important risk factors for carotid stent fracture.
Carotid stent fracture is a rare complication after CAS and is associated with vessel angulation, calcification, and restenosis. In this series, fracture identification was independent of stroke, transient ischemic attack, and mortality.
本研究旨在确定颈动脉支架断裂的流行率、风险因素和临床相关性。
本前瞻性观察性研究于 2004 年 1 月开始，使用市售颈动脉支架进行。适应证包括无症状患者（狭窄>80%）、有症状患者（狭窄>60%）和溃疡性病变（>50%）。支架完整性在 12 个月时通过普通放射照相进行评估。2009 年 4 月，对 341 例接受颈动脉支架置入术且至少有 12 个月随访的连续患者系列进行了数据分析。
12 个月时支架断裂的发生率为 3.4%（95%置信区间，1.7%-6.1%）。323 例符合条件的患者中位临床随访时间为 30 个月（范围，12-64 个月）。治疗包括 23.6%的有症状患者。根据单因素分析，III 型钙化使支架断裂的几率增加了 4.5 倍以上（比值比[OR]，4.74；P=0.006），而>45 度的成角使支架断裂的几率增加了 6.5 倍（OR，6.51；P=0.008）。颈动脉支架细胞类型、支架长度和支架超支均与支架断裂发生率无关。支架断裂与中风（0%）、短暂性脑缺血发作（0%）或死亡（0%）无关。再狭窄与支架断裂显著相关（P<0.001）。多因素分析表明，III 型钙化（OR，3.90；P=0.029）和>45 度成角（OR，4.69；P=0.026）是颈动脉支架断裂的重要危险因素。
颈动脉支架断裂是 CAS 后的一种罕见并发症，与血管成角、钙化和再狭窄有关。在本系列中，支架断裂的识别与中风、短暂性脑缺血发作和死亡率无关。
