Department of Interventional Neuroradiology, University of Brasilia, Brasilia, Brazil.
J Neuroradiol. 2013 Mar;40(1):38-44. doi: 10.1016/j.neurad.2012.03.003. Epub 2012 May 24.
Carotid angioplasty with stenting (CAS) in patients with carotid stenosis (CS) has become more restricted in France especially since the disclosure of such studies as EVA-3S and Stent-supported percutaneous angioplasty of the carotid artery versus endarterectomy (SPACE). This report is of a series of CS cases contraindicated for endarterectomy that underwent CAS at a French center of interventional neuroradiology.
Fifty-five patients with symptomatic CS more than 60% consecutively submitted to CAS between September 2008 and February 2011. The primary endpoint was either death or stroke within 30 days of the procedure; a secondary goal was to identify any possible factors that might have influenced the success and outcome of the intervention.
The overall periprocedural stroke/death rate at 30 days was 5.4% (three out of 55 patients), with three non-disabling strokes and no deaths. Twenty-seven patients (49.1%) were treated with a cerebral protection device (CPD). Stent placement was achieved in all cases. Open- and closed-cell stents were implanted in 40 (72.7%) and 15 procedures (27.3%), respectively. Neither the use of a CPD, the carotid stent cell design nor any anatomical or technical factors were associated with a lower risk of stroke or death within 30 days of CAS.
CAS in symptomatic patients with CS contraindicated for endarterectomy in this selected French series proved feasible and safe, with acceptable levels of morbidity. Use of a CPD, type of stent (open- or closed-cell), and anatomical and technical factors had no influence on the success of the procedure or the outcome within 30 days of the operation.
颈动脉狭窄（CS）患者的颈动脉血管成形术和支架置入术（CAS）在法国受到了更多限制，尤其是在 EVA-3S 和颈动脉支架成形术与内膜切除术（SPACE）等研究结果公布之后。本报告是一家法国介入神经放射学中心对不适合进行内膜切除术的 CS 病例进行 CAS 治疗的系列病例。
2008 年 9 月至 2011 年 2 月期间，连续有 55 例症状性 CS 超过 60%的患者接受了 CAS。主要终点为术后 30 天内死亡或中风；次要目标是确定任何可能影响干预成功率和结果的因素。
30 天内的围手术期总卒中/死亡率为 5.4%（55 例患者中有 3 例），有 3 例非致残性中风，无死亡病例。27 例（49.1%）患者使用了脑保护装置（CPD）。所有病例均成功放置了支架。40 例（72.7%）植入开环支架，15 例（27.3%）植入闭环支架。CPD 的使用、颈动脉支架的细胞设计或任何解剖学或技术因素均与 CAS 术后 30 天内的卒中或死亡风险降低无关。
在这项法国的选择病例系列中，对不适合进行内膜切除术的有症状 CS 患者进行 CAS 证明是可行和安全的，且发病率可接受。CPD 的使用、支架类型（开环或闭环）、解剖学和技术因素对手术成功率和术后 30 天内的结果没有影响。
