Oszkinis G, Pukacki F, Juszkat R, Weigele J B, Gabriel M, Krasinski Z, Zieliński M, Krejza J
Department of General and Vascular Surgery, Poznań University of Medical Sciences Poznań, Poland -
Interv Neuroradiol. 2007 Dec;13(4):345-52. doi: 10.1177/159101990701300405. Epub 2008 Feb 1.
Surgical procedures designed to restore vascular patency for a recurrent stenosis following carotid endarterectomy (CEA) are burdened with technical difficulties as well as with the possibility of serious neurological complications. An endovascular approach employing transluminal percutaneous angioplasty and stenting (PTAS) is a promising solution to these problems. We aimed to evaluate the incidence of carotid artery restenosis following CEA, and to evaluate the safety and efficacy of treating post-CEA restenosis with an endovascular technique (PTAS). One hundred and two patients who underwent CEA for symptomatic and asymptomatic stenosis were included in the analysis. Clinical and sonographic follow-up examinations identified carotid artery restenosis in 16 patients, who fulfilled our criteria for endovascular treatment. Carotid PTAS was performed on symptomatic patients with a stenosis over 60% of the artery lumen (n=7) and in asymptomatic patients with a stenosis over 80% (n=9). The post-PTAS patients were evaluated by duplex sonography every three months over a 24 month follow-up period for evidence of restenosis. The cumulative incidence of post-CEA carotid restenosis qualifying for PTAS was 9.3% during an average 12-month follow-up interval. The average time from CEA to carotid PTAS was 11 months. All 16 endovascular procedures were technically successful. All of the carotid arteries were widely patent following PTAS. There were no immediate perioperative complications. One patient died two days after carotid PTAS from a cerebral hemorrhage. Thirteen of the 16 patients remained asymptomatic and had no sonographic evidence of significant restenosis during the 24- month post-PTAS follow-up period. One patient developed a symptomatic 80% restenosis proximal to the stent six months after carotid PTAS. Another patient developed an asymptomatic 60% restenosis proximal to the stent at 24 months. One patient was lost to follow-up. Following CEA, there is a significant risk of developing a symptomatic or high-grade carotid artery restenosis requiring correction. Endovascular treatment (PTAS) of a recurrent stenosis after CEA is a safe and effective alternative to repeat carotid surgery.
旨在恢复颈动脉内膜切除术（CEA）后复发性狭窄血管通畅性的外科手术面临技术难题，且存在严重神经并发症的可能性。采用经皮腔内血管成形术和支架置入术（PTAS）的血管内治疗方法是解决这些问题的一个有前景的方案。我们旨在评估CEA后颈动脉再狭窄的发生率，并评估采用血管内技术（PTAS）治疗CEA后再狭窄的安全性和有效性。分析纳入了102例因有症状和无症状狭窄而接受CEA的患者。临床和超声随访检查发现16例患者出现颈动脉再狭窄，这些患者符合我们的血管内治疗标准。对动脉管腔狭窄超过60%的有症状患者（n = 7）和狭窄超过80%的无症状患者（n = 9）进行了颈动脉PTAS。在24个月的随访期内，对接受PTAS后的患者每三个月进行一次双功超声检查，以评估再狭窄情况。在平均12个月的随访间隔期内，符合PTAS标准的CEA后颈动脉再狭窄的累积发生率为9.3%。从CEA到颈动脉PTAS的平均时间为11个月。所有16例血管内手术在技术上均获成功。PTAS后所有颈动脉均广泛通畅。围手术期无即刻并发症。1例患者在颈动脉PTAS后两天因脑出血死亡。16例患者中有13例在PTAS后24个月的随访期内无症状，且无超声显示明显再狭窄的证据。1例患者在颈动脉PTAS后6个月，支架近端出现有症状的80%再狭窄。另1例患者在24个月时，支架近端出现无症状的60%再狭窄。1例患者失访。CEA后，发生有症状或高度颈动脉再狭窄需要矫正的风险很大。CEA后复发性狭窄的血管内治疗（PTAS）是重复颈动脉手术的一种安全有效的替代方法。
