Veselka Josef, Zimolová Petra, Cerná Daniela, Stanka Pavel, Tomek Aleš, Srámek Martin
Cardiovascular Center, University Hospital Motol, 1st Medical School, Prague, Czech Republic Prague, Czech Republic.
Int J Angiol. 2008 Winter;17(4):207-10. doi: 10.1055/s-0031-1278311.
Stroke represents the third leading cause of death in developed countries and the leading cause of disability in the elderly. Because asymptomatic, surgically high-risk patients have been systematically excluded from randomized trials of carotid endarterectomy and medical therapy, the management of this group of patients is still controversial. A single-centre, single-operator registry was analyzed to evaluate feasibility and safety of carotid artery stenting (CAS) with distal protection devices in consecutive, asymptomatic, surgically high-risk patients who were scheduled for endovascular treatment of significant carotid stenoses.
A total of 122 consecutive, surgically high-risk, asymptomatic patients (150 carotid arteries, 59% men, mean [± SD] age 69±9 years) with severe carotid stenosis and one or more high-risk features for carotid endarterectomy were scheduled for CAS. All procedures were performed in a single centre by a single operator. All patients were prospectively asked to undergo a clinical 30-day follow-up.
A total of 154 stents were implanted in 150 carotid arteries. The primary success rate was 98.7%. The rates of stenosis before and after direct CAS were 81%±9% and 10%±13%, respectively. The median of fluoroscopic time of direct CAS was 6 min (range 2.5 min to 31.5 min). At 30 days, data were available in all patients. The combined 30-day mortality and stroke rate was 1.3%.
Short-term outcomes of CAS in asymptomatic, surgically high-risk patients treated by a single operator suggest a low periprocedural complication rate.
中风是发达国家第三大致死原因，也是老年人残疾的主要原因。由于无症状、手术高风险患者被系统地排除在颈动脉内膜切除术和药物治疗的随机试验之外，这组患者的治疗仍存在争议。分析了一项单中心、单操作者登记研究，以评估在计划接受血管内治疗严重颈动脉狭窄的连续无症状、手术高风险患者中，使用远端保护装置进行颈动脉支架置入术（CAS）的可行性和安全性。
共有122例连续的、手术高风险、无症状患者（150条颈动脉，男性占59%，平均年龄[±标准差]69±9岁），患有严重颈动脉狭窄且具有一项或多项颈动脉内膜切除术高风险特征，计划接受CAS治疗。所有手术均在单中心由一名操作者完成。所有患者均被前瞻性地要求接受30天的临床随访。
共在150条颈动脉中植入了154个支架。主要成功率为98.7%。直接CAS术前和术后的狭窄率分别为81%±9%和10%±13%。直接CAS的透视时间中位数为6分钟（范围2.5分钟至31.5分钟）。在30天时，所有患者都有可用数据。30天的合并死亡率和中风率为1.3%。
由一名操作者治疗的无症状、手术高风险患者CAS的短期结果表明围手术期并发症发生率较低。
