Department of Neurosurgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, Japan.
Neuroradiology. 2012 May;54(5):481-6. doi: 10.1007/s00234-011-0902-y. Epub 2011 Jul 6.
Selection of the appropriate diameter of stent is difficult in patients with the size mismatch between the internal carotid artery (ICA) and the common carotid artery (CCA). Although stent overexpansion (SOE) in the ICA after carotid artery stenting (CAS) is suspected of producing restenosis, SOE has not been well established. We discuss its incidence, predictors, and outcomes.
We retrospectively reviewed follow-up angiographs of 206 CAS-treated arteries in 201 patients who had undergone CAS. SOE was defined as angiographic evidence of an intimal gap between the non-stented normal and the dilated stented ICA at the distal stent edge. We also collected data on the patients' clinical status, comorbidities, and radiological and procedural data. Patients with SOE were further followed up closely by duplex ultrasound scans.
SOE was detected in nine of 206 CAS-treated ICAs (4.4%). Univariate analysis revealed a significant association between SOE and open-cell stents, the stent diameter (p < 0.01), pre-procedural stenosis, the ICA diameter, ICA/CCA ratio, and the ICA/stent ratio (p < 0.05). Entering these variables into a logistic regression model, open-cell stents were the only variable that significantly increased the risk for SOE (OR 2.36; 95% CI 0.99-4.60; p < 0.05). During a mean clinical follow-up of 31.1 months (range 24-39 months), none of the patients with SOE developed new neurologic ischemic symptoms, stent-edge stenosis, or in-stent restenosis.
SOE after CAS was not associated with clinical adverse effects. This study suggests that the diameter of stent should be determined by reference to the CCA diameter without respect to the ICA diameter.
在颈内动脉（ICA）和颈总动脉（CCA）大小不匹配的患者中，选择合适直径的支架较为困难。虽然颈动脉支架置入术（CAS）后 ICA 支架过度扩张（SOE）被怀疑会导致再狭窄，但 SOE 尚未得到充分证实。我们探讨了其发生率、预测因素和结果。
我们回顾性分析了 201 例接受 CAS 治疗的患者的 206 条颈内动脉的随访血管造影。SOE 定义为在远端支架边缘，未支架的正常 ICA 与扩张的支架 ICA 之间存在血管内间隙的血管造影证据。我们还收集了患者的临床状况、合并症以及影像学和手术数据。对存在 SOE 的患者进行了密切的超声随访。
在 206 条 CAS 治疗的 ICA 中，有 9 条（4.4%）发现 SOE。单因素分析显示，SOE 与开孔支架、支架直径（p<0.01）、术前狭窄、ICA 直径、ICA/CCA 比值和 ICA/支架比值显著相关（p<0.05）。将这些变量纳入逻辑回归模型后，开孔支架是唯一显著增加 SOE 风险的变量（OR 2.36；95%CI 0.99-4.60；p<0.05）。在平均 31.1 个月（24-39 个月）的临床随访中，无 SOE 患者发生新发神经缺血症状、支架边缘狭窄或支架内再狭窄。
CAS 后 SOE 与临床不良事件无关。本研究表明，支架直径应参考 CCA 直径来确定，而无需考虑 ICA 直径。
