Vascular and Interventional Radiology Unit, Department of Radiological Sciences, "Sapienza" University of Rome, Italy.
J Endovasc Ther. 2012 Dec;19(6):749-56. doi: 10.1583/JEVT-12-3944MR.1.
To analyze a 12-year experience performing carotid artery stenting (CAS) with cerebral protection.
In accord with NASCET criteria, 672 patients underwent CAS at our hospital between November 1999 and September 2011 for de novo or postsurgical restenosis; among these, 636 patients (474 men; mean age 68 ± 6.8 years, range 63-85) had a minimum 6-month follow-up, which qualified them for this analysis. The majority of patients (381, 59.9%) were symptomatic; 47 patients had staged bilateral CAS procedures (total of 683 procedures). A cerebral protection device was used in 94.7%. Patients underwent duplex ultrasound and clinical evaluation during follow-up. Neurological adverse events were correlated with plaque morphology, patient age >80 years, learning curve, and spasm.
Technical success was achieved in all cases. Neurological events [3 (0.4%) major strokes, 8 (1.2%) minor strokes, and 11 (1.6%) transient ischemia attacks] occurred in 22 (3.2%) of the 683 cases within 30 days of the procedure (no events in follow-up). These involved 5 (2.0%) of the 255 asymptomatic patients and 17 (4.5%) of the 381 symptomatic patients (p=0.001). Neurological events proved to be higher in patients >80 years (6.4% vs. 2.7% of patients <80 years, p<0.05) and in those with complex plaque morphology (6.1% vs. 1.0% in stable plaques, p<0.001). After a mean follow-up of 76 ± 32.4 months, 478 (70%) patients were alive, with a 30-day mortality of 1.9% (none due to stroke). In-stent stenosis occurred in 9 (1.3%) stents and was resolved with angioplasty or re-stenting. The primary patency rate was 98.7%.
CAS is a valid technique for the treatment of carotid occlusive disease, with a very low rate of in-stent stenosis. Neurological complications were correlated with complex plaque morphology, which makes accurate pretreatment evaluation of the lesion mandatory if good CAS outcomes are to be achieved.
分析使用脑保护装置行颈动脉支架置入术（CAS）的 12 年经验。
根据 NASCET 标准，1999 年 11 月至 2011 年 9 月期间我院对 672 例初发或手术后再狭窄患者进行了 CAS 治疗；其中 636 例（474 例男性；平均年龄 68±6.8 岁，范围 63-85 岁）有至少 6 个月的随访，符合本分析标准。大多数患者（381 例，59.9%）为症状性；47 例患者行分期双侧 CAS 治疗（共 683 例）。94.7%使用了脑保护装置。患者在随访期间接受了超声双功检查和临床评估。神经不良事件与斑块形态、患者年龄>80 岁、学习曲线和痉挛相关。
所有病例均达到技术成功。术后 30 天内 683 例中有 22 例（3.2%）发生神经事件[3 例（0.4%）大卒中和 8 例（1.2%）小卒中，11 例（1.6%）短暂性脑缺血发作]（随访中无事件）。其中 5 例（2.0%）无症状患者和 17 例（4.5%）症状性患者发生神经事件（p=0.001）。>80 岁患者神经事件发生率更高（6.4% vs. <80 岁患者 2.7%，p<0.05），复杂斑块形态患者发生率更高（6.1% vs. 稳定斑块患者 1.0%，p<0.001）。平均随访 76±32.4 个月后，478 例（70%）患者存活，30 天死亡率为 1.9%（均非死于卒中）。9 例（1.3%）支架内发生狭窄，通过血管成形术或再次支架置入解决。初始通畅率为 98.7%。
CAS 是治疗颈动脉闭塞性疾病的有效技术，支架内狭窄率很低。神经并发症与复杂斑块形态相关，如果要获得良好的 CAS 结果，有必要对病变进行准确的术前评估。
