Felli M M G, Alunno A, Castiglione A, Malaj A, Faccenna F, Jabbour J, Laurito A, Stavri D, Gossetti B
Paride Stefanini Department of Vascular Surgery, Policlinico Umberto 1, Rome, Italy.
Int Angiol. 2012 Oct;31(5):420-6.
Ischemic stroke represents a major health problem and it is an important cause of long-term disability. The aim of this study was to compare short-term and mid-term results of carotid endarterectomy and stenting.
During a three-year period, we enrolled 300 patients with carotid stenosis that fit with Stroke Prevention and Educational Awareness Diffusion (SPREAD) guidelines and we performed 150 carotid endarterectomy operations (CEA) and 150 carotid artery stenting procedures (CAS) with distal protection devices. All patients underwent preoperative and postoperative: neurological examination, ultrasound imaging, magnetic resonance imaging (MRI) and cognitive tests; moreover all patients were submitted to preoperative, intraoperative and postoperative Transcranial Doppler (TCD) monitoring, in order to detect microembolic signals (MES).
Mortality was zero; two patients developed myocardial infarction in the CEA group during follow-up. The main post-operative results after endarterectomy versus CAS were respectively: neurological deficit: 1.3% vs. 3.3%, embolic lesions at postoperative MRI: 4% vs. 34% and worsening of cognitive tests: 4% vs. 25.3%.
CEA seems to be the treatment of choice for carotid stenosis, due to its low rate of mortality and morbidity, especially in asymptomatic patients; CAS should be carried out only in particular subgroup of cases, such as: restenosis, previous neck surgery or radian therapy, anatomical high bifurcation or extended lesions. Ongoing multicenter randomized trials may give a definitive answer to this matter.
缺血性中风是一个主要的健康问题，也是导致长期残疾的重要原因。本研究的目的是比较颈动脉内膜切除术和支架置入术的短期和中期结果。
在三年期间，我们纳入了300例符合中风预防与教育意识传播（SPREAD）指南的颈动脉狭窄患者，进行了150例颈动脉内膜切除术（CEA）和150例使用远端保护装置的颈动脉支架置入术（CAS）。所有患者均接受术前和术后的：神经学检查、超声成像、磁共振成像（MRI）和认知测试；此外，所有患者均接受术前、术中和术后的经颅多普勒（TCD）监测，以检测微栓子信号（MES）。
死亡率为零；CEA组有2例患者在随访期间发生心肌梗死。内膜切除术与CAS术后的主要结果分别为：神经功能缺损：1.3%对3.3%，术后MRI上的栓塞性病变：4%对34%，认知测试恶化：4%对25.3%。
由于CEA的死亡率和发病率较低，尤其是在无症状患者中，它似乎是颈动脉狭窄的首选治疗方法；CAS仅应在特定的病例亚组中进行，如：再狭窄、既往颈部手术或放射治疗、解剖学高位分叉或广泛性病变。正在进行的多中心随机试验可能会对此问题给出明确答案。
