Department of Neurosurgery, Seoul National University, Bundang Hospital, Seongnam, South Korea.
Neurosurgery. 2010 Nov;67(5):1438-42; discussion 1442-3. doi: 10.1227/NEU.0b013e3181f07c97.
Traditional carotid artery stenting (CAS) consists of predilatation, optional deployment of embolic protection devices, stenting, and poststent angioplasty. Each step carries a risk of thromboembolism.
To design a new and simplified procedural protocol, suboptimal balloon angioplasty without routine poststenting balloon dilatation, and to describe the efficacy this protocol in terms of procedural risks and angiographic and clinical outcomes.
Over a period of 6 years, 161 carotid artery stenoses in 156 consecutive patients were treated by CAS with embolic protection devices. Among them, 110 lesions in 107 patients (68.3%) were treated by our simplified method (symptomatic, > 50% stenosis; asymptomatic, > 70% stenosis). Overall, 98 lesions (88.3%) had severe stenosis (> 70%).
The mean stenosis was reduced from 77% to 10% after CAS. A persistent neurological deficit developed in 2 patients from thromboembolism. Hemodynamic insufficiency developed in 14 lesions during CAS (12.7%). The ipsilateral stroke and mortality rate was 4.5% within 1 month after CAS (asymptomatic, 3.6%; symptomatic, 4.8%). Over a mean of 19 months of follow-up, additive angioplasty was performed in 2 patients as a result of progressive restenosis (≥ 50%). A comparison of the balloon sizes of the prestent angioplasty for group 1 (balloon, ≤ 4 mm) and group 2 (balloon, ≥ 5 mm) showed no difference in restenosis between the groups at 15 months of follow-up after CAS.
Our CAS technique with suboptimal prestenting angioplasty without routine use of poststenting dilatation is safe, simple, and efficient with acceptable risks.
传统颈动脉支架置入术（CAS）包括预扩张、选择性使用栓塞保护装置、支架置入和支架后血管成形术。每个步骤都有血栓栓塞的风险。
设计一种新的简化程序方案，即次优球囊血管成形术，不常规进行支架后扩张，并描述该方案在程序风险以及血管造影和临床结果方面的疗效。
在 6 年的时间里，我们使用栓塞保护装置对 156 例连续患者的 161 处颈动脉狭窄进行了 CAS 治疗。其中，107 例患者的 110 处病变（68.3%）采用我们的简化方法进行治疗（症状性，>50%狭窄；无症状性，>70%狭窄）。总体而言，98 处病变（88.3%）有严重狭窄（>70%）。
CAS 后平均狭窄从 77%降至 10%。2 例患者因血栓栓塞导致出现持续性神经功能缺损。在 CAS 过程中，14 处病变出现血流动力学不足（12.7%）。CAS 后 1 个月内同侧卒中发生率和死亡率为 4.5%（无症状性，3.6%；有症状性，4.8%）。在平均 19 个月的随访期间，由于进展性再狭窄（≥50%），有 2 例患者需要进行附加血管成形术。对预支架血管成形术的球囊大小进行分组（球囊≤4mm 为组 1，球囊≥5mm 为组 2），在 CAS 后 15 个月的随访中，两组之间的再狭窄没有差异。
我们的 CAS 技术采用次优预支架血管成形术，不常规进行支架后扩张，安全、简单、有效，风险可接受。
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