Shabaneh B, Dougherty K, Hernandez E, Strickman N, Krajcer Z
Texas Heart Institute at St Lukes Episcopal Hospital, Huston, TX, USA. zvonkomd@aol. com
J Cardiovasc Surg (Torino). 2010 Dec;51(6):865-72.
Despite distal embolic protection (DEP) during carotid artery stenting (CAS), there is still an appreciable risk of stroke, especially in symptomatic patients and octogenerians. The mechanism of embolic events is possibly related to microembolization of debris remaining on or forming on stent struts. We evaluated the safety of using aspiration thrombectomy after CAS.
Between August 2006 and July 2010, 80 symptomatic and asymptomatic patients with severe carotid artery stenosis (>80%) underwent CAS utilizing DEP. After completion of CAS and before removal of DEP, an aspiration catheter was passed through the CAS segment. Both extracted volume and the DEP were visually examined. The primary endpoint was stroke and death at 30 days. These patients were divided into two groups, Group 1 (N=7) comprised those who had aspiration thrombectomy to treat no-flow or an acute neurologic change that occurred during CAS. Group 2 (N=73) comprised patients that underwent prophylactic aspiration thrombectomy. Outcomes were then compared to a control group (N=925) who had CAS with DEP, but without aspiration thrombectomy.
Moderate to large amounts of debris were extracted from the CAS segment in the majority of thrombectomy patients (90%). There was one death (1%) and one stroke (1%) in the thrombectomy groups, while the control group had 3.0% rate of death and stroke (P=0.83).
Aspiration thrombectomy recovers large to moderate amounts of debris and is safe and does not increase adverse periprocedural events. A large scale, randomized trial with magnetic resonance imaging (MRI) is needed to further investigate our findings.
尽管在颈动脉支架置入术（CAS）期间采用了远端栓子保护（DEP），但仍存在明显的卒中风险，尤其是在有症状的患者和八旬老人中。栓塞事件的机制可能与残留在支架支柱上或在支架支柱上形成的碎片的微栓塞有关。我们评估了CAS术后使用血栓抽吸术的安全性。
在2006年8月至2010年7月期间，80例有症状和无症状的严重颈动脉狭窄（>80%）患者接受了采用DEP的CAS。在CAS完成后且在移除DEP之前，将一根抽吸导管穿过CAS节段。对抽出的体积和DEP进行肉眼检查。主要终点是30天时的卒中和死亡。这些患者被分为两组，第1组（n = 7）包括那些进行血栓抽吸术以治疗CAS期间出现的无血流或急性神经功能改变的患者。第2组（n = 73）包括接受预防性血栓抽吸术的患者。然后将结果与一组对照组（n = 925）进行比较，该对照组接受了采用DEP的CAS，但未进行血栓抽吸术。
在大多数接受血栓抽吸术的患者（90%）中，从CAS节段抽出了中等到大量的碎片。血栓抽吸术组有1例死亡（1%）和1例卒中（1%），而对照组的死亡率和卒中率为3.0%（P = 0.83）。
血栓抽吸术可回收大量到中等量的碎片，且安全，不会增加围手术期不良事件。需要进行一项大规模的、采用磁共振成像（MRI）的随机试验来进一步研究我们的发现。
